THE  LIBRARY 
OF 

THE  UNIVERSITY 

OF  CALIFORNIA 

LOS  ANGELES 


SOUTHERN    BRANCH 

UNIVERSITY  OF  CALIFORNIA 
LIBRARY 

LOS   ANGELES,  CALIF, 


yf- 


GENERAL  ADVICE  REGARDING  THE 
USE  AND  PRESERVATION  OF  THE 
EYES,  EARS,  NOSE,  AND  THROAT 


BY 

HENRY  O.  REIK,  M.D. 

FORMERLY    ASSOCIATE   IN   OPHTHALMOLOGY   AND   OTOLOGY    IN 

THE  JOHNS   HOPKINS  UNIVERSITY  AND   SURGEON  IN 

THE  BALTIMORE  EYE,  EAR  AND  THROAT 

HOSPITAL,  BALTIMORE, 

MARYLAND 


ILLUSTRATED 


PHILADELPHIA 

F.  A.  DAVIS  COMPANY,  PUBLISHERS 
1912 

62- 


COPYRIGHT,  NOVEMBER,  1912 

BY 
F.  A.  DAVIS  COMPANY 


Copyright,  Great  Britain.    All  Rights  Reserved 


Philadelphia,  Pa.,  U.  S.  A. : 

Press  of  F.  A.  Davis  Company 

1914-16  Cherry  Street 


"KE. 


PREFACE. 


FIFTEEN  years  of  experience  as  a  specialist  in 
diseases  of  the  eye,  ear,  nose,  and  throat  has 
convinced  the  author  that  the  majority  of 
persons  suffering  from  serious  affections  of  these 
organs  have  arrived  at  that  stage  of  their  dis- 
eases either  through  ignorance  of  the  normal  use 
and  functions  of  these  parts  of  the  body  or  as  the 
result  of  neglecting  to  properly  care-for  them. 
The  child  is  not  expected  to  know  that  snoring 
generally  means  obstructed  respiration,  that  re- 
curring attacks  of  pain  in  the  ear  mean  an 
abnormal  growth  in  the  nose  or  throat,  nor  that 
inability  to  clearly  see -the  school  blackboard,  or 
headaches  following  study,  are  indications  of  bad 
eyes.  In  very,  very  many  instances  parents, 
though  more  might  well  be  expected  of  them,  are 
but  little  wiser.  Disinclination  to  study,  a  tend- 
ency to  "hook  school,"  or  failure  to  maintain 
a  satisfactory  class  standard  are  much  more  fre- 
quently due  to  poor  vision  or  eye-strain  than  to 
original  sin;  parents  are  too  prone  to  attribute 
a  dislike  of  books  to  laziness  or  wickedness,  and 
to  try  various  forms  of  punishment,  when  a 
proper  pair  of  glasses  would  really  make  that 

(3) 


4  PREFACE. 

child  as  fond  of  reading  and  study  as  are  his 
classmates.  What  percentage  of  fathers  and 
mothers  realize  even  the  immediate  dangers  of 
enlarged  tonsils  or  adenoid  growths,  not  to  men- 
tion the  more  remote,  but  oftentimes  serious, 
sequelae  of  these  abnormalities  that  are  so 
common  in  childhood? 

Second  only  to  the  crime  of  not  properly  safe- 
guarding the  health  of  his  children  is  the  sin  the 
adult  commits  in  neglecting  to  care  for  himself. 
Men  and  women  doing  the  finest  kind  of  eye- 
work  in  improperly  or  insufficiently  lighted 
rooms;  absolute  disregard  for  ventilation  in 
offices  and  work  rooms,  often  even  in  the  homes 
of  the  wealthy;  failure  to  regard  colds  in  the 
head  or  purulent  discharges  from  the  ear  as  of 
any  consequence  until  some  dangerous  complica- 
tion arises,  such  as  pneumonia  or  meningitis; 
these  are  conditions  commonly  observed  and  at- 
tributable partly  to  ignorance,  partly  to  neglect. 

It  is  probably  safe  to  say  that  50  per  cent,  of 
the  practice  of  specialists  is  made  up  of  efforts 
to  correct  conditions  that  should  never  have  been 
permitted  to*  exist.  They  are  constantly  crying 
to  the  family  physician  and  to  the  public  that 
prevention  is  not  only  cheaper  but  easier  and 
better  than  cure;  that  proper  care  of  the  eyes  in 
early  life  prevents  the  onset  of  cataracts  and 


PREFACE.  5 

other  intraocular  diseases  in  old  age,  that  the 
removal  of  bad  tonsils  and  adenoid  growths 
permits  the  child  to  develop  normally  and  insures 
against  certain  affections  of  the  ear  and  of  the 
respiratory  tract,  that  proper  attention  to  colds 
in  the  head  and  early  treatment  of  running  ears 
would  wipe  out  80  per  cent,  of  the  cases  of  brain 
abscess  and  purulent  meningitis. 

Specialists  are  a  body  of  medical  experts  who 
have  devoted  time  and  study  to  some  special 
organs  of  the  body  and  who,  by  so  doing,  have 
acquired  not  only  a  certain  amount  of  knowledge 
of  their  functions  and,  the  means  of  restoring 
them  to  health  when  diseased,  but,  at  the  same 
time,  have  learned  how  a  healthy  condition  of 
these  organs  might  have  been  maintained.  This 
knowledge  they  pass  along  to  that  larger  por- 
tion of  the  medical  profession,  the  general  prac- 
titioners of  medicine,  the  family  doctors.  They, 
in  turn,  are  expected  to  ut.ilize  that  knowledge  in 
so  far  as  possible  and  to  instruct  their  patients 
in  the  simpler  measures.  Attainment  of  the 
latter  portion  of  this  desire  is,  however,  not  well 
provided  for;  the  family  physician  is  not  suffi- 
ciently often  consulted  regarding  preventive 
methods  and  the  specialist  is  usually  reserved 
for  more  or  less  serious  conditions  of  disease. 
Unfortunately  medical  men  have  not  had  suffi- 


6  PREFACE. 

cient  opportunity  to  use  their  knowledge  for 
instruction  of  the  laity.  Public  lecture  courses 
and  occasional  magazine  articles  reach  but  a 
small  proportion  of  the  public,  and  then  deal  with 
but  a  few  topics  relating  to  some  one  organ. 

It  is  with  the  idea  of  presenting  in  one  small 
volume,  at  a  price  low  enough  to  bring  it  within 
reach  of  all  who  desire  information  on  the  sub- 
ject, such  simple  facts  and  suggestions  relating 
to  the  care  of  the  eye,  ear,  nose,  and  throat  as 
will  enable  reasonably  intelligent  persons  to  keep 
those  special  organs  healthy  and  to  recognize 
evidences  of  abnormality  therein,  so  that  they 
may  promptly  seek  safe  advice  for  cure,  that  the 
author  has  undertaken  the  task  of  writing  this 
little  book. 

HENRY  O.  REIK,  M.D. 

506  CATHEDRAL  ST., 
BALTIMORE,  MD. 


CONTENTS. 


PAGE 

I.  THE  EYE  11 

Structure  and  Function  13 

Organic  Defects   18 

Eye-strain    24 

Removal  of  Eye-strain 31 

The  Eyes  in  Infancy  38 

Care   During   Childhood    41 

Crossed  Eyes  44 

Reading  Light  and  Position  47 

Wild  Hairs   48 

Foreign  Bodies   48 

Granular  Lids    49 

Styes    51 

Pink-eye  (Conjunctivitis)   51 

Iritis  and  Glaucoma 52 

Cataracts    53 

Tobacco  and  Alcoholic  Blindness  56 

Subjective  Sensations  that  Should  Call  Attention  to 

Possible  Eye  Disorders  57 

How  to  Make  Applications  to  the  Eyes 60 

II.  THE  EAR  65 

Malformations 73 

Foreign  Bodies  in  the  Ear 74 

Accumulation  of  Earwax  76 

Diseases  of  the  Drum  of  the  Ear 77 

"Catarrh"  of  the  Ear  80 

Nerve  Deafness  and  Deaf-mutism   82 

III.  THE  NOSE  AND  THROAT  87 

Nasal    Structure    89 

Rhinitis  (Cold  in  the  Head)    92 

Chronic  Rhinitis  (Nasal  Catarrh)  94 

Affections  of  the  Tonsils   104 

Adenoids    112 

(7) 


ILLUSTRATIONS. 


FIG.  FACE  PAGE 

1.  Section  of  an  eye  showing  various  layers 

and  most  important  elements  of  which 

it  is   composed.     (Colored.)    12 

2.  Proper  method   of  applying  drops  to   the 

eyes    62 

3.  Showing  lateral  aspects  of  nasal  chambers 

and  neighboring  structures.  The  tur- 
binate  bones  are  especially  well  de- 
picted. (Colored.) 90 

4.  View  of  throat  in  which  can  be  seen  small 

diseased  tonsils  and  parts  of  an  adenoid 
hanging  below  the  soft  palate  on  either 
side  of  the  mouth  108 


(9) 


L 
THE  EYE. 

OF  the  five  special  senses,  that  of  sight  is  un- 
questionably the  most  important  and  the  one  most 
highly  prized  by  the  great  majority  of  human 
beings.  This  is  reasonably  so,  for  what  greater 
calamity  can  befall  one  than  complete  loss  of 
vision?  How  sad  for  the  individual,  how  pa- 
thetic even  for  the  observer,  are  the  sightless  days 
of  those  who  have  previously  delighted  in  oc- 
cupations that  depended  upon  their  eyes;  think 
how  terrible  is  blindness  to  one  who  has  loved 
books  and  who  has  derived  his  chief  pleasure  in 
life  from  reading !  To  be  deprived  of  the  enjoy- 
ment of  art,  to  be  shut  out  from  observation  of 
all  the  beauties  of  nature,  to  be  forever  denied 
another  glimpse  of  the  faces  of  loved  ones;  can 
anything  more  depressing,  more  disheartening, 
be  imagined?  If  one  pauses  to  consider  these 
things  the  appreciation  of  good  sight  is  immeas- 
urably enhanced. 

If  then  we  fully  realize  the  fact  that  perfect 
vision  is  one  of  our  most  valuable  possessions  it 
would  seem  well  that  everyone  should  have  a 

(11) 


12  '  THE    EYE. 

clear  understanding  of  the  structure  of  the  eye 
and  its  physiological  action  in  the  function  of 
seeing,  some  knowledge  of  the  things  that  may 
happen  to  impair  sight,  and  the  ways  to  pre- 
vent or  avoid  such  catastrophes.  Before  we  can 
understand  the  workings  of  any  piece  of  machin- 
ery or  the  things  necessary  to  keep  it  in  working 
order  we  must  know  something  about  how  and 
of  what  it  is  made,  must  know  the  nature  of  the 
materials  entering  into  its  construction  and  what 
each  part  is  designed  to  do.  Just  so,  the  primary 
step  in  studying  any  organ  of  the  body  is  con- 
sideration of  its  formation  and  structure. 

Comparison  of  the  unknown  with  the  familiar 
object  is  an  easy  and  successful  method  of  teach- 
ing; man  reasons  from  that  which  he  knows  and 
understands  and  in  the  endeavor  to  conceive  a 
new  mechanism  it  helps  materially  if  he  can  com- 
pare it  with  something  of  which  he  already  has  a 
fair  conception.  The  human  eye  has  been  fre- 
quently and  aptly  compared  to  the  camera  of  the 
photographer  and,  since  kodakery  has  made  this 
instrument  a  familiar  one  to  so  large  a  part  of 
the  populace,  we  may  here  employ  the  comparison 
for  the  purpose  of  instruction.  The  sclerotic 
may  be  said  to  form  the  box ;  the  cornea  the  point 
of  entrance  for  light,  the  amount  of  which  is 
regulated  by  the  iris  acting  as  a  shutter;  the 


CORNEA 


IRIS 


OPTIC  NERVE 


VITREOUS 


Fig-.   1. — Section  of  an   eye  showing  various  layers  and  most 
important  elements  of  which  it  is  composed. 


STRUCTURE   AND    FUNCTION.  13 

choroid  furnishes  the  dark  lining  to  nature's 
camera;  the  lens  refracts  the  rays  of  light  and 
forms  an  inverted  image  of  objects  on  the  sensi- 
tized plate,  which  is  here  represented  by  the 
retina;  and  the  sensation  produced  by  this  nega- 
tive, when  transmitted  to  the  brain,  is  converted 
into  a  positive  and  we  "see"  the  picture.  Yet, 
how  inadequate  is  this  comparison,  how  insignifi- 
cant is  the  camera  produced  by  man  compared 
to  the  living  camera!  Consider  the  astounding 
adaptability  of  the  human  lens  which  can,  and  in 
the  normal  eye  without  perceptible  effort  on  our 
.part,  focus  for  either  near  or  distant  objects,  and, 
also,  the  remarkable  rapidity  with  which  one 
scene  follows  another  as  the  eye  roves  over  a 
landscape  and  yet  every  picture  is  received  upon 
the  same  plate. 

STRUCTURE  AND  FUNCTION. 

The  eyeball  is  a  nearly  spherical  body  about 
one  inch  in  diameter.  Externally  it  presents  a 
tough,  fibrous  coat  about  one  millimeter  in  thick- 
ness1, and  so  resistant  that  it  not  only  preserves 
the  shape  of  the  globe  but  affords  excellent  pro- 
tection to  the  delicate  contents.  The  front  por- 
tion of  this  external  coat,  the  cornea  (glassy  part 
of  the  eye),  is  transparent,  while  the  remaining 


14  THE    EYE. 

four-fifths,  the  sclerotic  (commonly  spoken  of 
as  "white  of  the  eye"),  is  opaque;  posteriorly  the 
sclera  is  perforated  for  admission  of  the  optic 
nerve,  a  direct  offshoot  of  special  fibers  from 
the  brain.  Just  within  the  sclera,  and  resting 
upon  it,  is  a  second  coat  or  membrane,  called  the 
choroid,  which  carries  most  of  the  blood-vessels 
of  the  eye  and  contains  a  considerable  amount  of 
pigment,  so  that  it  constitutes  a  dark  lining  for 
this  optical  apparatus.  As  this  coat  spreads  for- 
ward toward  the  cornea  its  character  changes 
somewhat,  muscle  tissue  being  developed  within 
it  to  form  the  ciliary  muscle — that  governs  the 
focusing  action  of  the  lens — and  finally  it  drops 
behind  the  cornea  in  the  form  of  a  delicate,  in- 
complete curtain — the  iris.  Both  the  choroid  and 
the  iris  are  covered  on  their  innermost  surfaces 
by  a  layer  of  flat,  pigmented  cells,  and  it  is  the 
varying  amount  of  pigment  in  these  cells,  par- 
ticularly of  the  iris,  which  determines  the  "color" 
of  the  eye.  If  a  large  amount  of  pigment  is 
present  we  say  the  iris  is  black,  or  the  individual 
has  a  black  eye,  while  if  less  in  amount  we  see 
brown,  gray  or  blue  eyes,  and  so  on  through 
varying  shades  of  color  down  to  the  pink  eye  of 
the  albino,  in  which  there  is  practically  no  pig- 
ment ;  the  pink  color  here  being  due  to  reflection 
from  the  deep  blood-vessels  through  the  un- 


STRUCTURE   AND   FUNCTION.  15 

colored  iris.  Dark-complexioned  people  will 
usually  have  dark  eyes  and  blondes  light  ones, 
but  there  is  no  scientific  foundation  for  the  popu- 
lar notion  that  dark  eyes  are  stronger  than  light 
ones.  It  is  rather  a  question  of  evolution,  and 
nature  has  provided  those  who  live  in  tropical 
countries  with  a  goodly  supply  of  pigment,  the 
better  to  protect  them  from  glaring  sunlight, 
whereas  the  more  temperate  and  cooler  countries 
furnish  a  larger  proportion  of  fair  eyes. 

The  iris  does  not  form  a  complete  curtain, 
but  has  a  round,  central  opening  through  which 
all  light  must  enter  the  eve,  and  which  varies 
in  size  in  accordance  with  the  amount  of  light 
entering;  when  we  are  in  a  darkened  room  the 
pupillary  opening  is  largest,  but  if  we  pass  out 
into  the  bright  light  the  sphincter  muscle  tissue 
of  the  iris  is  stimulated  to  contract  and  the  pupil 
is  reduced  in  size. 

The  lens,  situated  just  behind  the  pupil,  is 
soft,  transparent,  elastic,  and  contained  in  a  cap- 
sule suspended  by  a  circular  ligament  which  is 
attached  to  the  ciliary  muscle.  In  the  normal  eye 
the  lens  should,  in  a  state  of  rest,  bring  to  a 
focus  on  the  retina  parallel  rays  of  light,  that  is, 
rays  of  light  coming  from  an  object  twenty  feet 
or  more  away.  Should  we  desire  to  look  at  some 
nearer  object,  we  contract  the  ciliary  muscle,  the 


16  THE   EYE. 

lens  capsule  is  relaxed,  and  the  lens  substance, 
through  its  elasticity,  assumes  a  greater  con- 
vexity, and  thereby  becomes  stronger,  so  that  it 
is  enabled  to  focus  upon  the  retina  the  divergent 
rays  that  emanate  from  an  object  near  by.  A 
simple  experiment  to  illustrate  this  action,  which 
is  called  the  accommodation  of  the  eye,  may  be 
tried  in  this  way.  Look  at  some  object  across 
the  room  and  while  doing  so  pass  a  pencil  in 
front  of  the  eye ;  you  will  observe  the  latter  only 
indistinctly.  Now,  fixing  your  attention  upon 
the  pencil,  you  will  see  it  distinctly,  but  the  dis- 
tant object,  while  still  in  view,  has  now  become 
hazy ;  it  is  out  of  focus.  The  rapidity  with  which 
the  lens  successively  focuses  different  objects  at 
varying  distances  is  one  of  the  marvels  of  nature. 
As  soon  as  the  optic  nerve  penetrates  the 
sclera  and  choroid  it  spreads  out  over  the  latter 
in  a  thin  sheet,  the  retina,  which  is  one  of  the 
most  wonderful  tissues  of  the  body.  It  con- 
tains those  highly  specialized  elements  which 
enable  it  not  only  to  receive  the  image  of  an  ob- 
ject, but  to  transmit  the  impression  of  that  image, 
through  the  fibers  of  the  optic  nerve,  to  the  brain, 
where  its  registry  constitutes  what  we  call  sight. 
How  this  is  accomplished  is,  and  probably  must 
always  remain,  a  mystery.  Professor  Tyndall 
says:  "When  we  endeavor  to  pass  from  the 


STRUCTURE   AND   FUNCTION.  17 

phenomena  of  physics  to  those  of  thought,  we 
meet  a  problem  which  transcends  any  conceivable 
expression  of  the  powers  we  now  possess.  We 
may  think  of  the  subject  again  and  again — it 
eludes  all  intellectual  presentation — we  stand,  at 
length,  face  to  face  with  the  incomprehensible." 

The  retina  is  not  equally  sensitive  in  all  its 
parts  to  visual  impressions.  A  small  area,  called 
the  macula  lutea,  or  yellow  spot,  is  the  most 
sensitive  portion,  and  in  order  to  secure  a  clear 
and  accurate  view  of  any  object  we  direct  the 
eyes  toward  it  in  such  relative  positions  as  will 
allow  the  images  to  fall  upon  the  yellow  spot  of 
each  eye.  The  movements  of  the  eye  are  con- 
trolled by  a  set  of  six  muscles,  four  of  which  are 
so  arranged  that  they  can  direct  the  eye  upward, 
downward,  inward  or  outward,  and  the  remain- 
ing two,  working  in  conjunction  with  these,  give 
it  a  rotary  motion.  When  the  eyes  are  viewing 
distant  objects  the  visual  axes  of  the  two  are 
practically  parallel  and  the  muscles  are  at  rest. 
As  vision  is  fixed  on  closer  things  the  visual  axes 
begin  to  converge,  and  the  closer  the  object 
comes  to  the  eyes,  the  greater  must  become  the 
convergence  of  the  two  eyes.  You  will  remem- 
ber, also,  that  the  closer  the  object  approaches 
the  eyes  the  greater  must  be  the  accommodative 

action  of  the  lens.     The  harmonious  action  of 

2 


18  THE    EYE. 

these  two  sets  of  eye  muscles  is  such  that  con- 
vergence is  definitely  associated  with  the  act  of 
accommodation  without  conscious  effort,  and 
thus  binocular  vision,  the  simultaneous  use  of 
both  eyes,  is  maintained.  If  conjoint  action  of 
the  muscles  is  interfered  with  and  images  are 
formed  on  unrelated  portions  of  the  eyes,  two 
separate  images,  or  double  vision,  results. 
Should  the  dissociation  be  sufficiently  marked  to 
cause  one  eye  to  turn  in  or  out  much  more 
strongly  than  the  other,  we  say  that  eye  "squints" 
or  has  a  "cast." 

I   * 

ORGANIC  DEFECTS. 

Refraction  of  light  is  the  bending  which  its 
rays  undergo  in  passing  through  media  of  differ- 
ent density,  and,  according  to  physical  laws,  rays 
of  light  passing  from  the  air  through  a  medium 
of  ssuch  character  and  shape  as  the  human  lens 
are  converged  to  a  point  on  the  other  side, 
which  point  is  called  the  focus  of  the  lens.  An 
eye  that  refracts  parallel  rays  in  this  way  accu- 
rately upon  the  retina  is  said  to  be  emmetropic. 
Should  the  eyeball  be  flatter  than  normal,  that 
is,  have  a  shorter  anteroposterior  axis,  the  retina 
will  be  situated  in  front  of  the  focal  point  of  the 
lens  and,  hence,  will  not  receive  a  distinct  image ; 


ORGANIC  DEFECTS.  19 

just  as  in  the  use  of  your  camera,  if  your  plate 
and  lens  are  too  close  together — if  you  have 
focused  too  short — you  will  get  a  blurred  nega- 
tive. Such  an  eye  is  said  to  be  hypermetropic 
(sometimes  called  over  sighted  or  far-sighted). 
The  term  "far-sighted"  is  misleading,  has  caused 
much  confusion  in  the  public  mind,  and  should 
be  expunged  from  our  vocabulary.  The  hyper- 
metrope  is  not  far-sighted,  that  is,  he  does  not 
see  farther  than  the  normal-eyed  person.  He 
does  often  see  as  far  as  the  person  with  normal 
eyes,  but  he  does  even  that  well  by  a  trick.  It 
has  been  explained  that  the  normal  eye  is  in  a 
state  of  rest  when  looking  at  a  distant  object. 
That  is  to  say,  if  looking  at  some  object  in  the 
distance  the  eye  sees  it  without  making  any  effort 
whatsoever ;  the  eye  is  as  quiescent  as  the  photog- 
rapher's box  that  has  been  set  for  a  distant  view. 
Now,  if  the  hypermetrope  attempts  to  see  that 
same  object  from  the  same  distance  he  can  do  so 
only  by  correcting  his  natural  defect ;  this  he  does 
by  calling  upon  his  ciliary  muscle  to  focus  the 
lens  sufficiently  to  bring  the  image  forward  to 
the  plane  of  his  retina.  This  means  that  even  for 
distant  vision,  when  the  eye  should  be  in  a  state 
of  rest,  almost  constant  muscular  effort  is  re- 
quired and  power  that  should  be  saved  as  a 
reserve  force  for  close  work  is  being  drawn  upon. 


20  THE    EYE. 

The  person  with  normal  eyes  looks  at  distant 
things  without  effort  and  uses  his  focusing 
ability  only  for  looking  at  closer  objects,  the 
greatest  amount  of  power  being  required  in  such 
acts  as  reading,  writing,  sewing,  etc.  He  comes 
to  such  close  work  with  rested  and  active  muscles. 
The  hypermetrope,  on  the  other  hand,  being 
forced  to  use  muscular  power  in  his  distant 
vision,  comes  to  his  close  work  with  muscles  that 
are  tired  and  is,  besides,  required  to  call  forth 
an  extra  amount  of  energy ;  this  accounts  for  the 
discomfort  experienced  by  these  people  when 
doing  school  work  or  following  occupations  re- 
quiring close  application  of  the  eyes.  The  act  of 
focusing  for  distant  objects  is  to  them  an  un- 
conscious thing,  of  course,  the  ciliary  muscle 
being  what  is  called  an  involuntary  muscle,  one 
that  responds  perfunctorily  when  the  eye  is 
directed  at  something  and  not  because  of  special 
effort  put  forth,  and,  so,  they  are  not  aware  that 
in  claiming  "far-sight"  they  are  taking  advantage 
of  the  normal-eyed  competitor ;  it  was  referred  to 
as  a  trick,  but,  it  is  unconsciously  performed. 

Myopia,  commonly  called  "near-sightedness" 
or  "short-sightedness,"  is  an  exactly  opposite 
condition,  that  is,  the  eyeball  is  elongated — has 
an  unusually  long  anteroposterior  axis — and  the 
image  is  naturally  formed  in  front  of  the  retina. 


ORGANIC  DEFECTS.  21 

Here  again  a  blurred  image  would  result;  com- 
paring the  condition  once  more  to  photography, 
it  matters  not  whether  you  have  focused  a  bit 
beyond  or  a  bit  short  of  the  plate,  the  result  will 
be  a  blur.  The  hypermetrope  has  the  power  to 
alter  his  defect  by  focusing,  but  the  myope  has 
not;  the  ciliary  muscle  is  fully  relaxed  in  the 
normal  eye  and  the  lens  set  for  distant  vision, 
and,  as  it  cannot  be  further  relaxed,  the  myope 
cannot  reduce  the  strength  of  his  lens  to  meet 
the  abnormal  condition.  He  must  therefore  ap- 
proach closer  to  the  object  or  hold  it  closer  to  his 
eyes,  if  he  would  see  it.  You  have  observed  the 
very  myopic  person  holding  small  things  very 
close  to  his  face  or  putting  the  face  down  to  the 
desk  until  it  almost  touched  the  book;  and  you 
know  they  are  shut  off  from  distant  vision  so  that 
they  cannot  recognize  friends  across  the  street,  or 
sometimes  even  at  much  closer  range. 

Hypermetropia  and  myopia  are  the  principal 
defects  of  the  eye  due  to  variations  in  size,  but 
there  is  a  third  and  perhaps  a  more  important 
one,  that  is  the  result  of  abnormal  shape.  Astig- 
matism is  a  condition  of  faulty  refraction  that 
results  from  defective  curvature  of  the  corneal 
or  lens  surfaces.  If,  for  instance,  the  cornea  is 
not  a  true  section  of  a  sphere,  but  has  a  greater 
degree  of  curvature  in  one  meridian  than  in 


22  THE   EYE. 

another,  light  will  be  refracted  by  it  unequally  in 
these  different  meridians  and,  again,  a  blurred 
image  formed.  An  eye  may  be  perfect  as  to  the 
length  of  its  anteroposterior  axis,  but  have  an 
irregularity  of  curvature  of  the  corneal  surface; 
this  condition  is  called  simple  astigmatism,  and 
may  be  either  hypermetropic  or  myopic,  accord- 
ing as  the  defect  tends  to  cause  a  focusing  of  part 
of  the  image  beyond  or  in  front  of  the  retina. 
Astigmatism,  however,  occurs  not  only  as  such 
alone,  but  may  occur  in  combination  with  hyper- 
metropia  or  myopia;  a  condition  known  as 
compound  hypermetropic  or  compound  myopic 
astigmatism.  That  is,  an  eye  may  be  not  only 
shortened  or  elongated,  but  have  an  irregular 
corneal  surface  as  well. 

Astigmatism  is  existent  to  some  degree  in 
almost  all  eyes.  It  sounds  rather  startling  to  say 
that  there  are  few,  if  any,  perfect  eyes.  Consider 
for  a  moment,  though,  that  nature  has  succeeded 
in  making  very  few  perfect  spherical  bodies ;  the 
world  itself  is  believed  to  be  flattened  at  the  poles. 
Careful  scientific  measurement  will  show  the 
presence  of  refractive  errors  in  nearly  all  eyes, 
though  the  error  may  not  be  of  sufficient  degree 
to  cause  any  inconvenience,  or  the  person  having 
the  unsuspected  defect  may  live  in  that  blissful 
state  by  virtue  of  the  fact  that  he  has  the  strength 


ORGANIC  DEFECTS.  23 

to  bear  the  tax  upon  his  muscles  without  suffer- 
ing discomfort.  The  amount  of  discomfort  pro- 
duced, however,  by  unsuspected  astigmatic  errors 
almost  surpasses  belief.  Thousands  of  people  are 
suffering  from  the  far-reaching  effects  of  refract- 
ive errors  without  for  a  moment  suspecting  that 
the  eyes  are  in  any  way  connected  with  their 
troubles ;  but  of  that  we  shall  speak  later  on. 

There  is  still  another  optical  defect  to  be  con- 
sidered, one  which  comes  to  all  eyes  alike  if  they 
reach  the  period  of  old  age.  Presbyopia,  com- 
monly called  "old  sight,"  is  simply  a  natural 
diminution  of  power  to  focus  or  accommodate 
the  eye  for  different  distances.  Ordinarily  this 
loss  of  power  begins  at  about  the  fortieth  year  of 
life  and,  as  age  creeps  on,  the  lens  gradually 
undergoes  a  change,  loses  its  elasticity,  and  the 
power  to  assume  greater  convexity  fails.  The 
most  obvious  feature  of  this  change  is  the  gradual 
receding  of  the  near-point  of  vision  as  shown 
by  the  necessity  for  holding  the  book  or  paper 
farther  from  the  eyes  when  reading.  Persons 
between  forty  and  fifty,  who  are  loath  to  put  on 
glasses,  often  insist  that  they  can  read  as  well  as 
ever,  while,  at  the  same  time,  you  observe  that 
they  are  holding  the  paper  at  arms'  length  to 
enable  them  to  do  so;  a  fact  which  proves  of 
itself  that  they  are  failing  in  visual  power.  A 


24  THE   EYE. 

patient  recently  rather  cleverly  described  this 
mental  attitude  in  his  own  case  by  saying  "Well 
doctor,  I  guess  I  shall  have  to  come  to  the 
glasses.  I  can  still  see  as  well  as  ever;  my  eyes 
are  good,  but  my  arms  are  too  short." 

EYE-STRAIN 

In  the  preceding  paragraphs  we  have  con- 
sidered only  the  structure  and  function  of  the 
eye,  referring  mainly  to  normal  organs,  and  have 
alluded  to  abnormalities  of  formation  only  in 
sufficient  degree  to  establish  a  basis  for  under- 
standing such  irregular  formations  and  per- 
formances as  constitute  or  serve  to  produce 
diseased  conditions. 

In  all  the  possible  errors  of  refraction  that 
we  have  pointed  out,  however,  it  has  been  shown 
that  there  is  imperfect  focusing  of  objects  on  the 
retina,  and  in  order  to  secure  that  perfect  focus- 
ing which  is  essential  to  distinct  vision  the  deli- 
cate muscles  of  the  eye  are  kept  in  more  or  less 
constant  action.  Remember  that  tb«  muscles  of 
the  iris  and  of  the  ciliary  body  cannot  be  seen  in 
the  ordinary  dissection  of  the  eye,  but  become 
visible  only  under  a  microscope.  When  we  con- 
sider the  small  size  of  these  muscles  it  is  sur- 
prising that  they  are  able  to  work  so  continuously 


EYE-STRAIN.  25 

and  to  perform  such  enormous  tasks  with  such 
comparative  ease.  In  very  many  instances  of 
slightly  defective  eyes  they  carry  the  burden 
without  complaint;  in  some  cases,  where  the 
error  is  gross  and  the  burden  too  heavy,  they 
rebel  and  the  victim  seeks  assistance  promptly ;  in 
very  many  more  instances,  possibly  in  the 
majority  of  all  cases,  they  struggle  on,  making  a 
desperate  effort  to  carry  the  load,  become 
l^mined,  and  cause  a  variety  of  distressing  symp- 
toms, not  limited  to  the  region  of  the  eye  alone, 
but  wic  ^spread  throughout  the  system.  You  are 
familiar  ^Khe  size  and  power  of  the  biceps 
muscle  of  the  arm  and  with  the  large,  strong  leg 
muscles^and,^^wise,  know  the  effect  of  long 
exertion  of  theseknuscles ;  how  when  a  man  has 
walked  all  day  or  swung  an  axe  for  hours  not 
only  do  those  strong  muscles  of  the  leg  and  arm 
become  tired  and  sore,  but  he  feels  the  effect  all 
over  his  body;  perhaps  he  has  headache,  cannot 
digest  his  food,  does  not  sleep  well,  and  even 
such  organs  as  the  heart  and  kidneys  show  the 
result  of  overexertion.  Compare  with  those 
muscles  the  delicate,  macroscopically  invisible, 
internal  eye  muscles  and  you  will  not  be  sur- 
prised at  how  far-reaching  may  be  the  effect  of 
straining  them  by  prolonged,  incessant  labor. 
Thousands  of  us  think  little  of  working  our  eyes, 


26  THE   EYE. 

probably  defective  ones  at  that,  sixteen  hours  or 
more  per  day,  year  after  year,  yet  wonder  why 
they  feel  tired  at  times,  or  find  it  hard  to  under- 
stand how  such  a  local  strain  can  account  for 
general  ill  health  or  a  derangement  of  some  other 
organ  of  the  body.  Did  we  work  any  other 
muscle  or  set  of  muscles  in  the  body  one-half  so 
hard  or  so  constantly  as  we  do  the  ciliary  muscles 
of  the  eyes,  we  would  be  physical  wrecks  in  short 
order.  It  is  the  direct  and  reflex  effects  of  eye- 
strain  that  we  shall  now  take  up  for  brief  con- 
sideration. 

Usually  the  first  symptom  which  calls  atten- 
tion to  a  refractive  error  is  the  occurrence  of 
discomfort  whenever  the  eyes  are  employed  in 
close  work.  This  irritation  may  manifest  itself 
in  various  ways:  there  may  be  simply  a  tired 
feeling  about  the  eyes ;  a  sense  of  drowsiness  or 
heaviness  of  the  eyelids ;  a  tendency  to  fall  asleep 
after  a  very  brief  period  of  reading;  twitching 
of  the  lid  muscles,  sometimes  amounting  to  a 
regular  spasm  that  forces  closure  of  the  lids  for 
some  seconds,  until  recovery  takes  place  and  the 
eye  can  be  opened  for  the  resumption  of  work; 
a  vague  sense  of  heaviness  or  discomfort  over  the 
brow;  and,  a  pronounced  headache.  These  may 
be  classified  as  local  evidences  of  eye-strain  and 
indicate  rather  the  acute  symptoms  or  those  ob- 


EYE-STRAIN.  27 

served  in  the  beginning  of  the  trouble.  Among 
the  characteristic  local  features  of  the  more  pro- 
longed or  chronic^cases  of  eye-strain  are  to  be 
enumerated:  congested  eyes  ("bloodshot"), 
giving  one  the  appearance  of  being  an  alcoholic; 
red  and  encrusted  lids ;  styes,  which  are  infections 
made  possible  through  local  weakness  of  the  tis- 
sues; narrowly  contracted  lid  apertures  or 
wrinkles  under  the  lids  or  over  the  brows,  from 
the  constant  muscular  effort  made  to  overcome 
visual  defects;  and,  pain  in  the  eyes  or  forehead. 
When  we  come  to  enumerate  the  reflex  symp- 
toms of  eye-strain,  symptoms  that  are  referred 
to  other  parts  of  the  body  than  the  eyes,  we  enter 
upon  a  very  broad  subject.  There  is  nothing  in 
the  whole  realm  of  medicine,  however,  a  knowl- 
edge of  which  is  of  greater  importance  and  value 
to  the  intelligent  layman  than  this  fact,  that  a 
defect  in  the  eyes  can  be  the  cause  of  disturbances 
and  derangements  of  portions  of  the  body  ap- 
parently remote  from  the  eyes.  Sometimes  these 
reflex  symptoms  occur  in  conjunction  with  one 
or  more  of  the  local  eye  symptoms  mentioned 
above.  Quite  frequently  they  appear  without 
any  localizing  eye  symptoms,  and  then  the  patient 
may  suffer  for  a  long  time  before  his  attention 
is  attracted  to  the  eyes  as  a  possible  cause  of 
trouble.  To  add  to  the  difficulties  of  solving  this 


28  THE   EYE. 

puzzle,  a  definite  ocular  defect  does  not  always 
cause  the  same  symptoms  in  a  number  of  dif- 
ferent persons.  Thus,  a  certain  degree  of  hyper- 
metropic  astigmatism,  let  us  say,  produces  in  the 
first  man  inflamed  lids  or  red  eyes ;  in  the  second, 
headaches;  for  a  third,  some  form  of  nervous 
manifestation,  such  as  twitching  of  the  lid 
muscles,  choreic  movements  of  the  face,  or  even 
epileptic  convulsions.  It  is  these  facts  that  make 
it  necessary  to  consider  carefully  the  remote 
evidences  of  eye-strain  and  how  they  can  be 
detected. 

Headache  is  perhaps  the  most  common  of 
these  reflex  symptoms  and  the  one  most  widely 
recognized  now  as  of  ocular  origin ;  probably  the 
vast  majority  of  repeated  or  recurring  head- 
aches are  attributable  to  defective  eyes.  Often- 
times the  connection  is  recognized  from  the  fact 
that  the  headache  appears  in  association  with  or 
immediately  after  use  of  the  eyes  for  close  work, 
as  in  reading,  writing,  sewing,  drawing,  fancy 
work,  visits  to  art  galleries,  or  sightseeing. 
Car-sickness  is  a  kindred  type  of  eye-headache, 
the  effect  upon  the  eyes  of  watching  the  various 
objects  rapidly  passed  being*much  the  same  as 
that  of  reading  or  other  close  work.  Occasionally 
the  headache  does  not  appear  as  an  immediate 
consequence  of  the  tax  upon  the  eyes,  but  comes 


EYE-STRAIN.  29 

on  some  hours  afterward;  as  witnessed  in  some 
persons  who  awake  with  a  headache  in  the  morn- 
ing after  employment  of  the  eyes  at  night.  The 
character  of  the  headaches  induced  by  overstrain 
of  the  eyes  varies  greatly,  and  ranges  from  slight 
pain  in  or  over  the  eyes  to  the  most  severe  type 
of  "sick-headache";  in  the  latter  group  of  cases 
the  eyes  may  have  withstood  the  strain  for  con- 
siderable periods  of  time  and  then  there  comes 
an  explosion,  as  it  were,  the  headache  being  ac- 
companied by  nausea,  vomiting,  serious  depres- 
sion, the  whole  attack  lasting  for  several  days 
and  completely  incapacitating  the  sufferer.  A 
not  inconsiderable  percentage  of  drug  fiends  have 
acquired  their  bad  habits  from  the  use  of  reme- 
dies for  the  relief  of  headaches,  and  the  number 
of  hard-worked  men  and  women  (especially  book- 
keepers, clerks,  sewing  girls,  milliners,  and  others 
engaged  in  service  requiring  close  application  of 
the  eyes)  that  are  daily  consuming  large  quan- 
tities, often  dangerous  quantities,  of  headache 
powders  and  tablets  is  as  alarming  as  it  is  sur- 
prising; in  nine  cases  out  of  ten  they  do  not  need 
drugs,  but  proper  attention  to  their  eyes. 

Next  to  headaches,  one  of  the  most  commonly 
observed  reflex  effects  of  eye-strain  is  disturbed 
digestion.  It  has  long  been  recognized  that  any 
nervous  shock  to  the  system  may  arrest  the 


30  THE    EYE. 

process  of  digestion  and  produce  nausea,  and  it 
is  easy  to  understand  that  persistent  and  pro- 
longed nervous  agitation  can  so  derange  the 
digestive  function  that  a  fixed  impairment  there- 
of results.  Many  long-standing  cases  of  dyspep- 
sia, indigestion,  or  other  stomach  disorders,  that 
have  resisted  years  of  treatment  by  lavage  and 
medicines,  have  been  promptly  cured  upon  the 
patient  having,  for  some  other  reason,  had  his 
eyes  cared  for.  When  digestive  disturbances 
occur  to  people  who  are  using  their  eyes  a  great 
deal,  and  there  is  present  no  recognisable  organic 
lesion  of  the  stomach,  suspicion  should  be  turned 
upon  the  eyes  and  an  examination  for  some  visual 
defect  made. 

A  long  list  of  reflex  disorders  of  ocular  origin 
that  might  now  be  given  would  consume  an  un- 
necessary amount  of  space  and  perhaps  prove 
more  tedious  than  helpful  to  the  reader.  Suffice 
it  to  say  that  a  large  number  of  cases  of  nervous 
trouble,  hysteria,  neurasthenia,  nervous  prostra- 
tion, chorea,  and  epilepsy  are  brought  about  or 
provoked  by  the  strained  use  of  defective  eyes. 
The  writer  desires  to  avoid  misunderstanding  on 
this  question.  No  one  would  claim  that  all  cases 
of  these  diseases  are  due  to  eye-strain  nor  that 
they  can  aways  be  cured  or  even  relieved  by  treat- 
ment of  the  eyes ;  it  is  only  meant  to  explain  that 


REMOVAL  OF  EYE-STRAIN.  31 

eye-strain  certainly  is  a  causative  agent  in  the 
production  of  these  serious  conditions  in  a  con- 
siderable number  of  instances.  In  the  most 
serious  condition  mentioned,  for  instance,  epi- 
lepsy, it  has  been  repeatedly  shown  that  eye-strain 
may  be  the  factor  that  provokes  the  epileptic 
seizure,  and  that  the  wearing  of  glasses  to  cor- 
rect the  visual  defect  prevents  further  attacks. 
In  this  disease,  as  in  most  of  the  reflex  conditions 
referred  to,  there  is  an  underlying  weakness  of 
the  nervous  system,  or  of  some  specific  organ, 
that  manifests  itself  whenever  the  eye-strain 
reaches  a  point  of  severity  sufficient  to  overcome 
the  patient's  normal  resistant  power.  In  such 
cases  cure  or  relief  follows  removal  of  the 
exciting  cause;  the  excitable  nervous  system,  or 
weak  stomach  or  other  organ,  cannot  be  disposed 
of,  but  can  be  protected. 

REMOVAL  OF  EYE-STRAIN. 

From  what  has  been  said  above  concerning 
the  causes  of  these  refractive  errors,  it  is  evident 
that  no  amount  of  treatment  will  remove  them, 
since  we  cannot  change  the  shape  of  the  eye  to 
any  desired  form.  We  can,  however,  by  means 
of  proper  glasses,  bring  about  a  condition  of 
emmetropia.  Where  hypermetropia  exists,  a 


32  THE   EYE. 

glass  with  convex  surfaces  is  used  to  converge 
the  light  more  strongly  and  relieve  the  lens  and 
ciliary  muscle  of  that  necessity.  In  myopia,  a 
concave  glass  is  required  to  cause  a  divergence 
of  the  rays,  and  thus  extend  the  focus  of  the 
lens  backward  through  the  abnormally  long  eye 
to  the  retina.  For  astigmatic  conditions,  glasses 
are  ground  so  as  to  have  a  different  power  of 
refraction  for  different  meridians. 

Do  not  suppose  for  a  moment,  however,  that 
the  adjustment  of  correcting  glasses  is  purely  a 
mathematical  problem.  The  human  eye  is  not  a 
mathematical  optical  instrument  and  cannot  be 
treated  as  such.  In  almost  every  case  one  must 
consider  a  number  of  other  points  of  great  im- 
portance, points  which  deal  with  the  anatomy  and 
physiology  of  the  eye,  the  general  health  and 
muscular  tone  of  the  patient,  and  these  can  be 
properly  appreciated  only  by  one  who  possesses  a 
thorough  knowledge  of  medicine.  The  selection 
and  prescribing  of  the  correct  glasses  is  just  as 
much  the  practice  of  the  art  of  medicine  as  is 
the  choosing  and  prescribing  of  the  proper  me- 
dicinal remedy  for  any  diseased  condition.  Con- 
sequently, the  only  competent  individual  to 
examine  the  eye  is  the  physician  who  has  given 
special  attention  to  the  science  of  ophthalmology. 
The  newspapers,  street-cars,  and  other  adver- 


REMOVAL  OF  EYE-STRAIN.  33 

tising  media  are  filled  with  the  alluring  signs  of 
the  optical  quack,  the  most  attractive  feature  of 
whose  advertisement  is  "Examination  made  free 
of  charge."  The  thoughtful  will  see  at  once  that 
the  optician  can  no  more  afford  to  "give  some- 
thing for  nothing"  than  can  any  other  business 
man,  and  those  who  fall  into  his  trap  will  likely 
discover  that  the  advertisement  is  a  falsehood. 
The  optician  is  in  no  sense  qualified  to  make  the 
proper  examination  for  glasses.  He  has  his 
legitimate  field  of  labor,  but  it  should  be  under- 
stood by  all  that  there  exists  the  same  difference 
between  the  oculist  and  the  optician  as  between  i 
the  physician  and  the  druggist;  the  latter  may 
occasionally  give  relief  by  administering  a  dose 
of  medicine,  but  one  would  hardly  argue  from 
this  that  he  is  competent  to  prescribe,  or  safe  to 
consult,  for  any  ailment  whatever.  Some  one  of 
my  readers  may  be  wearing  with  comfort  glasses 
selected  by  one  of  these  men,  or  even  chosen  from 
the  tray  of  a  peddler  or  street  vendor,  but  such 
person  has  taken  grave  risks  with  the  most 
valuable  organ  of  his  body,  and  a  large  percent- 
age of  the  people  who  pursue  such  a  course  suffer 
therefore  in  one  way  or  another. 

It  is  the  business  of  the  physician  to  diagnose 
disease,  ascertain  the  cause  thereof,  and  to  pre- 
scribe the  correcting  remedy;  while  to  the  phar- 


34  THE    EYE. 

macist,  on  the  other  hand,  is  entrusted  the  duty 
of  preparing  drugs,  compounding  the  prescrip- 
tions, and  supplying 'the  patient  with  the  ordered 
remedies.  In  like  manner,  the  oculist  studies  the 
character  of  ocular  defect,  the  alterations  in 
physiological  action  produced  thereby,  considers 
the  anatomical,  physiological,  and  pathological 
elements  in  the  case,  and  then  calculates  the  char- 
acter of  glass  that  can  best  promise  good  vision 
and  comfort;  the  optician,  like  the  druggist,  has 
a  kindred  but  a  different  profession — that  of 
constructing  from  a  simple  piece  of  glass  a  lens 
•  which  shall  have  the  desired  refractive  power, 
and  so  adjusting  it  in  frames  that  the  patient  can 
wear  it  in  front  of  the  eyes  in  such  position  that 
its  varying  refractive  portions  shall  properly 
cover  the  defective  parts  of  the  eye — a  profession 
based  upon  a  thorough  knowledge  of  optics  and 
marked  mechanical  skill.  Neither  of  these  men 
can  change  positions;  the  physician,  unless  also 
educated  in  pharmacy,  is  not  capable  of  filling  his 
own  prescriptions ;  the  pharmacist  knows  little  or 
nothing  of  the  art  of  prescribing  for  diseases; 
the  oculist  is  not  taught  to  grind  lenses  nor  fit 
frames;  the  optician  is  utterly  incapable  of  ap- 
preciating the  various  medical  elements  at  stake 
in  the  ocular  conditions  that  require  correcting 
glasses,  and  is  therefore  unfit  to  examine  eyes 


REMOVAL  OF  EYE-STRAIN.  35 

for  such  purpose  or  to  prescribe  glasses.  It  is  a 
very  serious  mistake  to  suppose  that  these  eye 
examinations  are  simple  matters,  and  that  any 
glass  that  one  can  see  through  is  good  enough 
to  use ;  as  we  have  attempted  to  show,  it  is  usually 
not  a  question  of  what  one  can  see,  but  whether 
they  can  see  normally  without  tax  upon  the  eye 
or  system,  and  glasses  are  given  most  frequently 
not  to  make  people  see  better  so  much  as  to  make 
them  see  well  with  comfort  and  safety.  The 
jeweler,  the  pharmacist,  the  department-store 
keeper,  and  the  spectacle  vendor  are  not,  then, 
the  proper  persons  to  examine  eyes  or  furnish 
glasses.  The  examination  should  be  made  by  an 
expert  oculist  and  his  prescription  for  glasses  be 
filled  by  a  skilled  optician. 

In  this  connection  one  more  word  of  caution 
may  not  be  out  of  place.  Some  of  the  depart- 
ment stores  and  jewelers  advertise  that  their 
spectacle  departments  are  presided  over  by  a 
physician  or  a  trained  man  who  poses  under  some 
high-sounding  title,  such  as  "Optometrist"  or 
"Graduate  Refractionist."  In  the  vast  majority  of 
instances  these  are  fraudulent  pretenses.  As  to 
the  alleged  physicians  in  these  places;  they  are 
sometimes  men  who  have  failed  to  pass  their 
medical  examinations,  or  failed  to  win  success  or 
professional  standing  in  their  medical  work,  or, 


36  THE    EYE. 

worse,  have  simply  assumed  the  title ;  of  one  thing 
you  can  be  quite  sure,  no  self-respecting  physician 
of  any  ability  will  enter  into  such  an  alliance  to 
defraud  the  public.  As  regards  the  gentlemen  of 
special  titles  referred  to,  the  title  is  the  most 
imposing  and  important  portion  of  their  equip- 
ment ;  usually  they  are  very  deficient  in  knowledge 
of  either  medicine  or  optics.  It  must  be  acknowl- 
edged that  not  all  oculists  and  opticians  are  as 
highly  skilled  and  reliable  as  they  might  be. 
Some  eye  specialists  are  excellent  surgeons  in  the 
treatment  of  that  organ,  and  have  only  moderate 
ability  as  ref ractionists ;  if  you  were  to  undergo 
any  surgical  operation  you  would  choose  the  most 
skilled  and  expert  surgeon  at  your  command;  in 
the  same  way  it  is  equally  to  be  recommended 
that  when  needing  an  examination  for  glasses 
you  should  choose  the  eye  specialist  who  is  most 
skilled  in  this  particular  part  of  his  branch  of 
medicine.  In  selecting  an  optician  a  similar  rule 
should  apply ;  go  to  that  one  who  is  reputed  to  do 
the  most  careful  work  in  making  and  adjusting 
spectacles. 

Some  people  object  strenuously  to  the  wearing 
of  spectacles,  especially  by  children,  and  express 
the  fear  that  "if  they  once  begin  to  wear  them 
they  are  afraid  they  can  never  leave  them  off 
again."  To  fight  against  the  assistance  which  art 


REMOVAL  OF  EYE-STRAIN.  37 

may  supply  in  this  direction  is  as  absurd  as  to 
refuse  to  eat  when  hungry  or  to  sit  down  when 
tired.  Why  should  they  not  be  worn  through 
life,  if  by  their  aid  discomfort  is  removed  and 
sight  preserved;  while  through  their  lack  vision 
is  indistinct,  eye-pains  or  headaches  prevail,  and 
the  tendency  is  toward  the  destruction  of  the  eye 
and  the  general  impairment  of  health  ?  It  would 
be  just  as  sensible  for  the  lame  man  to  refuse  the 
aid  of  crutches — because  he  can  never  hope  to 
walk  again  without  them.  The  use  of  glasses  in 
early  life,  of  the  proper  kind  and  at  the  proper 
time,  has  saved  many  a  person  not  only  from  im- 
mediate discomforts,  but  from  calamities  far 
worse  than  the  ill  looks  or  slight  inconvenience 
of  having  to  wear  spectacles.  We  once  believed 
that  nearly  every  one  would  have  cataracts  if 
they  lived  long  enough.  It  is  known  now  that 
cataracts  and  many  other  serious  affections  of 
the  eyes  in  elderly  people  are  the  result  of  neglect 
in  early  life,  and  that  by  the  use  of  glasses  at  the 
proper  time  to  prevent  eye-strain,  with  its  conse- 
quent injury  to  the  nervous  and  vascular  struc- 
tures of  the  eye,  such  diseases  can  be  avoided. 
Indeed,  as  the  result  of  the  past  twenty  years  or 
so  of  careful  and  accurate  refraction  work,  cata- 
racts are  much  less  common  today  than  they  were 
a  generation  ago. 


38  THE    EYE. 

THE  EYES  IN  INFANCY. 

The  need  for  special  care  of  the  eyes  begins 
at  a  very  early  period  of  life.  It  is  the  duty  of 
both  the  doctor  and  the  nurse  to  watch  the  baby's 
eyes  carefully  during  the  first  week  of  life,  as  one 
of  the  worst  diseases  to  which  the  eye  is  liable  is 
prone  to  make  its  appearance  about  the  second  or 
third  day,  rarely  later,  and  unless  very  prompt 
medical  attention  is  secured  it  may  result  in  blind- 
ness. This  affection  is  called  ophthalmia  neona- 
torum  (meaning  eye-inflammation  of  the  new- 
born), and  it  is  a  purulent  disease  of  great 
virulency.  The  lids  become  red  and  intensely 
swollen,  and  pus  flows  out  very  freely,  often 
seeming  to  reappear  as  fast  as  it  is  wiped  away. 
If.  neglected  the  cornea  soon  ulcerates,  and  in 
such  cases,  even  if  the  inflammation  is  then 
checked,  an  opacity  appears  where  healing  takes 
place,  and  vision  is  forever  interfered  with ;  in  the 
less  favorable  cases,  where  the  disease  succeeds 
in  forcing  a  perforation  of  the  cornea,  the  interior 
of  the  eye  is  infected  and  the  whole  structure 
destroyed,  leaving  only  a  shrunken,  sightless 
globe.  In  our  public  institutions  for  the  blind  a 
larger  percentage  can  trace  their  affliction  to  this 
disease  than  to  any  other  single  source.  And  yet, 
it  is  a  preventable  disease.  The  infection  really 


THE  EYES  IN  INFANCY.  39 

occurs  at  the  time  of  birth  by  contamination  with 
infective  vaginal  secretions.  If  immediately  after 
birth  the  eyes  are  carefully  cleansed  and  a  few 
drops  of  a  i  per  cent,  nitrate  of  silver  solution,  or 
of  a  5  per  cent,  solution  of  argyrol  or  protargol, 
be  placed  upon  the  eyeball,  the  disease  will  not 
develop,  in  the  majority  of  instances,  even  when 
the  child  has  been  delivered  through  a  canal  be- 
lieved to  have  been  infected.  Inasmuch  as  such 
drops,  properly  used,  can  do  no  harm,  it  should 
be  the  universal  routine  practice  of  physicians 
and  midwives  to  treat  the  baby's  eyes  in  this  way. 
The  fact  that  this  custom  has  not  been  more 
widely  adopted  depends  in  some  degree  upon  the 
attitude  of  the  public  toward  purely  preventive 
medicine;  many  parents  are  averse  to  having 
drops  applied  to  the  baby's  eyes  unless  there  is 
visible  evidence  of  existing  disease.  Of  course 
this  position  is  due  really  to  lack  of  understand- 
ing, and  when  they  come  to  fully  realize  that 
there  is  no  danger  in  so  simple  ,a  precautionary 
measure  against  a  possible  infection,  and  further 
recognize  the  fact  that  the  disease  to  be  guarded 
against  is  so  terrible  a  one  that  if  it  once  gets  a 
start  it  is  almost  certain  to  produce  a  serious 
condition  if  not  complete  blindness,  the  prejudice 
against  this  preventive  measure  at  least  must 
disappear. 


40  THE    EYE. 

To  those  poor  mothers  who  are  entrusted  to 
midwives,  women  who  are  not  educated  in  the 
employment  of  preventive  medicines,  we  can  only 
say  that  the  very  moment  you  observe  any  evi- 
dence of  eye  trouble  in  the  infant  you  must  im- 
mediately demand  the  services  of  a  physician;  in 
the  larger  cities,  where  this  disease  is  far  more 
prevalent  than  in  country  districts,  it  is  always 
possible  to  secure  the  attendance  of  an  expert 
from  one  of  the  many  eye  hospitals.  The  affec- 
tion is  amenable  to  treatment  if  this  be  instituted 
promptly,  but  delay  is  extremely  dangerous,  even 
a  few  hours  often  sufficing  to  impair  the  vision 
seriously.  Do  not  waste  time  in  following  the 
suggestions  of  old  women  nurses  who  place  un- 
bounded faith  in  the  use  of  "mother's  milk,"  "tea- 
leaves,"  "chamomile  tea,"  etc.  Such  remedies 
are  absolutely  valueless  in  this  or  any  other  af- 
fection of  the  eyes,  and  not  infrequently  do  much 
harm.  Those  who  have  the  care  of  the  baby,  in 
giving  the  necessary  attention  to  a  case  of  this 
kind,  must  be  very  careful  thoroughly  to  cleanse 
the  hands  after  having  touched  the  patient  or  any 
article  that  might  have  become  contaminated  by 
the  secretion,  for  a  minute  particle  of  this  secre- 
tion introduced  into  the  eye  of  an  adult  may  cause 
rapid  loss  of  that  eye;  the  same  disease  is  ap- 
parently much  more  virulent  in  the  adult  eye 


CARE  DURING  CHILDHOOD.  41 

than  in  the  baby's,  and  the  eye  may  be  destroyed 
in  the  short  space  of  a  few  hours  in  spite  of 
prompt  and  vigorous  treatment.  The  attendants 
should,  then,  most  carefully  cleanse  their  hands 
after  every  treatment  or  washing  of  the  baby's 
eyes,  and  special  care  should  be  exercised  to  pre- 
vent others  from  using  the  same  towels  or  hand- 
kerchiefs employed  in  the  sick-room  for  any 
purpose. 

CARE  DURING  CHILDHOOD. 

During  infancy  the  child  should  be  guarded 
against  glaring  lights  in  the  house,  or  direct  sun- 
light out  of  doors,  and  the  growing  youth  should 
be  encouraged  to  take  part  in  outdoor  amuse- 
ments rather  than  devote  too  much  time  to  books 
and  small  toys.  The  inflammatory  affections  of 
the  eye  are  usually  quickly  recognized  and  sub- 
mitted to  treatment.  Errors  of  refraction,  how- 
ever, are  not  so  apt  to  be  detected  promptly 
during  childhood,  and  it  would  seem  to  be  a  part 
of  wisdom  to  have  every  child's  eyes  examined  at 
the  beginning  of  school  life,  and,  where  defects 
are  found,  to  have  other  examinations  from  time 
to  time  thereafter.  If  this  were  universally  done 
it  would  aid  greatly  in  the  advancement  of  those 
children  who  start  out  in  life  with  congenitally 
defective  eyes,  would  secure  for  them  proper  care 


42  THE   EYE. 

of  the  eyes,  and  prevent  the  serious  effects  of  eye- 
strain,  and  would  lessen  the  chances  of  conveying 
these  defects  to  future  generations.  We  fre- 
quently meet  with  children  who  have  been 
severely  punished  both  at  home  and  at  school 
because  of  a  pronounced  dislike  of  study  or  an 
apparent  dullness  in  school  work,  with  inability 
to  keep  up  with  their  classes,  when  investigation 
shows  that  the  children  are  in  no  way  to  blame, 
but  are  laboring  under  a  handicap  in  the  form  of 
defective  vision. 

Dr.  S.  D.  Risley,  of  Philadelphia,  who  has 
devoted  much  time  to  a  consideration  of  the  in- 
fluence of  school  work  upon  the  eyes,  and  who 
has  published  a  most  comprehensive  paper  on 
School  Hygiene,  says:  "It  is  highly  important 
that  every  child  seeking  to  enter  the  schools 
should  be  subjected  to  a  systematic  examination 
as  to  the  state  of  their  vision,  and,  where  this  is 
found  defective,  parents  should  be  notified  and 
advised  of  the  probable  harm  which  will  result 
from  the  school  work  if  professional  advice  is  not 
secured.  The  skillful  correction  of  the  errors  of 
refraction  in  our  children's  eyes,  by  glasses,  would 
go  far  to  arrest  the  acquisition  of  near-sight  and 
its  attending  pathological  conditions,  and  in  most 
cases  would  prevent  also  the  discomfort  which 
precedes  and  accompanies  the  increase  of  refrac- 


CARE  DURING  CHILDHOOD.  43 

tion.  The  following  suggestions  should  be  borne 
in  mind  as  important:  (a)  Sufficient  light,  prop- 
erly admitted  to  the  schoolroom,  should  be  re- 
garded as  a  fundamental  requirement  in  school- 
house  architecture.  The  light  should  be  admitted 
from  the  left  side  of  the  pupils,  and  the  ratio  of 
window  surface  to  floor  surface  should  never  fall 
below  one  to  five,  and  this  should  be  exceeded 
in  many  localities,  on  the  north  side  of  buildings 
and  on  the  ground  floors,  (b)  The  desks  and 
seats  should  be  of  such  a  pattern  as  will  permit 
independent  adjustment  as  to  height  and  size,  to 
meet  the  requirements  of  individual  pupils  and  to 
insure  upright  sitting,  (c)  Instruction  should 
be  imparted  as  far  as  possible  by  means  of  black- 
boards, wall  maps,  charts,  and  orally,  instead  of 
by  work  at  a  near  point,  as  with  pencil  and  paper 
or  slate.  Where  the  work  must  be  done  at  a 
near  point,  a  pen  and  black  ink  should  be  used 
instead  of  a  lead-pencil  or  slate  and  pencil,  (d] 
The  work  required  to  be  done  at  home  should  be 
in  a  large  measure  abandoned,  or  at  least  largely 
reduced.  (e)  A  more  elastic  curriculum  of 
study  is  desirable  for  pupils  with  weak  eyes  or 
feeble  health,  which  will  permit  the  lengthening 
of  the  school  life  and  at  the  same  time  admit  of 
steady  promotion.  (/)  Great  care  should  be 
exercised  in  the  selection  of  properly  printed 


44  THE  EYE. 

textbooks.  Only  good  paper,  and  type  no  smaller 
than  eight-point,  or  preferably  ten-point,  are  ad- 
missible in  schoolbooks,  and  these  should  be  bold- 
faced and  well  spaced,  on  a  double-column  page. 
For  the  former  a  distance  of  two  millimeters  be- 
tween the  lines,  and  for  the  latter  a  distance  of 
two  and  one-half  millimeters,  should  be  required. 
(g)  In  writing,  the  central  position  of  the  paper 
should  be  maintained,  but  in  properly  lighted 
rooms  with  suitably  arranged  seating  the  kind  of 
script,  vertical  or  slanting,  will  depend  upon  the 
vertical  or  the  inclined  position  of  the  paper,  and 
may  safely  be  left  to  natural  selection." 

Some  of  these  suggestions  are  equally  adapt- 
able to  the  home  life  or  office  work  of  the  adult. 

CROSSED  EYES. 

A  "squint"  or  "cast"  of  the  eye  is  said  to 
exist  when  one  of  the  external  eye  muscles  acts 
in  excess  of  its  opponent  so  that  when  one  eye 
is  directed  straight  ahead  the  other  turns  in  or 
out,  up  or  down.  The  most  common  form  is  that 
known  as  "cross-eyed,"  and  generally  makes  its 
appearance  between  the  third  and  fifth  years  of 
age.  In  very  many  instances  the  mother  believes 
that  the  child  became  so  afflicted  through  fright, 
through  imitation  of  some  other  child  or 


CROSSED  EYES.  45 

servant,  or  as  the  result  of  an  accident  while 
under  the  supervision  of  a  careless  attendant. 
Generally  there  is  no  true  basis  for  this  reason- 
ing. It  is  at  about  this  age  that  the  child  begins 
to  use  its  eyes  for  close  work,  to  study  pictures 
attentively,  or  to  play  with  small  objects.  If  the 
child  has  a  high  degree  of  hypermetropia  it  is 
compelled  to  employ  considerable  muscle  power 
to  focus  near  objects  and  to  converge  the  two 
eyes  so  that  both  shall  participate  in  the  act  of 
seeing — binocular  vision.  Now  this  is  an  ex- 
treme tax  upon  the  delicate  muscles  of  the  young 
child,  and  something  has  to  give  way.  Close 
work  could  be  abandoned,  but  the  child,  not  being 
able  to  reason  out  the  cause  of  its  discomfort, 
does  not  arrive  at  that  conclusion.  Nature  then 
attempts  to  afford  partial  relief  by  giving  up  the 
effort  to  use  both  eyes  simultaneously,  doing 
away  with  the  converging  act.  As  the  two  eyes 
are  seldom  exactly  alike  in  these  children,  nature 
selects  the  better  one  for  seeing  purposes  and 
turns  the  more  defective  one  in  toward  the  nose, 
thus  throwing  it  out  of  commission.  Should  the 
eyes  be  very  nearly  alike  it  may  require  some 
time  to  determine  which  eye  shall  be  selected,  and 
in  such  cases  we  may  observe  the  child  squinting 
sometimes  with  one,  sometimes  with  the  other, 
eye  (alternating  squint),  until  nature  makes  her 


46  THE   EYE. 

selection  and  the  squint  of  one  eye  becomes  fixed. 
So,  crossed  eyes  are  not  usually  the  result  of  in- 
jury or  neglect  nor  evidence  of  the  acquirement 
of  bad  habits;  they  result  from  nature's  effort 
to  relieve  the  child  of  a  burden  imposed  upon  it 
by  a  serious  error  of  refraction. 

This  also  explains  why  in  its  early  stage  a 
crossed  eye  may  sometimes  be  made  to  assume 
its  proper  position  through  the  aid  of  proper 
glasses  to  correct  the  refractive  error.  Such 
children  should  be  placed  at  once  under  the  care 
of  a  competent  oculist.  If  the  condition  is 
neglected  until  the  eye  has  become  more  or  less 
fixed  in  its  faulty  position,  glasses  alone  will  not 
be  sufficient  to  correct  the  deformity;  then  an 
operation  will  be  required  to  bring  the  eye  back 
into  position,  and  glasses  will  still  have  to  be 
worn  to  maintain  it  so.  However,  practically  all 
cases  of  crossed  eyes,  even  of  many  years'  stand- 
ing, can  be  rectified,  and  when  one  considers 
what  a  difference  in  personal  appearance  it 
makes,  the  disagreeable  effect  of  such  an  eye 
upon  those  who  must  come  in  contact  with  the 
afflicted  person,  and  the  simplicity  of  the  opera- 
tion, it  looks  like  a  sin  against  the  community  to 
allow  such  persons  to  retain  their  deformity. 


READING  LIGHT  AND  POSITION.  47 

READING  LIGHT  AND  POSITION. 

We  are  too  often  careless  in  the  matter  of 
securing  good  light  to  work  and  read  by.  The 
most  desirable  source  of  light  is  from  above,  be- 
hind and  to  the  left  of  the  body,  and  it  should 
thoroughly  illumine  the  work  without  shining 
directly  or  casting  reflections  in  the  eyes.  As  an 
artificial  light  the  incandescent  electric  is  the 
best;  but  as  it  is  not  available  to  the  majority  of 
people,  dependence  must  still  be  placed  in  gas  or 
coal-oil.  The  use  of  incandescent  mantles  has 
much  improved  the  gaslight,  making  it  whiter, 
more  like  daylight,  and  also  much  steadier.  In 
country  districts  where  coal-oil  is  the  only  illumi- 
nant,  the  so-called  student-lamps  will  furnish  a 
very  satisfactory  light  for  reading  and  fine  work. 
The  points  of  most  importance  in  this  connection 
are  that  the  light  shall  be  sufficiently  bright  to 
thoroughly  illumine  the  work  without  dazzling 
reflections,  and  from  such  a  direction  as  to  avoid 
shadows  on  the  field  of  vision.  If  a  position  can- 
not be  taken  which  will  prevent  the  light  striking 
directly  upon  the  eye,  a  shade  may  be  worn  on 
the  forehead.  Reading  while  in  a  recumbent 
position  is  generally  inadvisable,  since  the  strain 
upon  the  eye  muscles  is  somewhat  increased  and 
it  is  difficult  to  secure  as  good  light  upon  the 


48  THE    EYE. 

book.  The  latter  is  the  chief  objection,  and  if 
pains  be  taken  to  place  the  couch  in  such  position, 
in  relation  to  the  windows  or  the  artificial  source 
of  lighting,  as  to  secure  a  proper  illumination  of 
the  reading  matter,  there  is  no  serious  objection 
to  reading  while  lying  down. 

WILD  HAIRS. 

Wild  hairs  are  eyelashes  which  have,  as  the 
result  of  inflammation  of  the  lids,  become  turned 
in  so  that  they  scratch  the  eyeball.  Sometimes 
they  may  produce  great  discomfort  and  injury, 
but  they  are  nothing  like  so  common  as  is 
generally  supposed,  and  very  many  people  pull 
out  their  lashes  under  the  mistaken  belief  that 
they  have  wild  hairs,  when  they  are  suffering 
from  irritation  due  to  some  entirely  different 
cause.  A  good  set  of  lashes  should  not  be  inter- 
fered with,  as  they  are  important  agents  in  pro- 
tecting the  eye  from  foreign  bodies. 

FOREIGN  BODIES. 

Travelers  on  the  railroad  and  laborers  en- 
gaged in  such  occupations  as  stone-cutting,  tool- 
grinding,  etc.,  are  constantly  in  danger  of  catch- 
ing foreign  bodies  in  the  eye,  and  such  injuries 


GRANULAR  LIDS.  49 

may  vary  in  effect  from  a  simple  temporary 
inconvenience  to  complete  loss  of  the  eye.  The 
best  means  to  prevent  such  accidents  is  to  wear 
some  simple  protection — spectacles  or  goggles. 
Unless  the  substance  imbeds  itself  in  the  cornea, 
its  most  common  hiding  place  is  just  under  the 
edge  of  the  upper  lid,  whence  it  can  easily  be 
removed  by  everting  the  lid  and  wiping  it  off. 
The  natural  tendency  of  foreign  bodies,  not  im- 
bedded, is  to  be  washed  along  toward  the  inner 
corner  of  the  eyelids,  where  they  give  no  trouble. 
A  very  common  practice  is  to  introduce  "eye 
stones"  or  flaxseed  under  the  lids  to  chase  out 
the  cinder  or  bit  of  dirt;  the  smooth  seed,  being 
naturally  carried  along  to  the  inner  corner,  is 
expected  to  push  the  foreign  body  before  it.  This 
is  not  a  good  practice,  however,  and  has  occa- 
sionally produced  considerable  trouble.  Unless 
the  foreign  body  can  be  readily  removed,  the 
prompt  assistance  of  an  expert  should  be  secured. 

GRANULAR  LIDS. 

The  condition  to  which  this  term  is  properly 
applied  is  the  disease  technically  called  "tra- 
choma," but  the  vast  majority  of  people  who 
think  they  have  granular  lids  are  merely  suffering 
from  a  slight  irritation  or  inflammation  of  the 


50  THE   EYE. 

lid  margins,  the  result  of  eye-strain.  True  tra- 
choma is  a  very  serious  disease,  a  specific  infec- 
tion of  the  tissue  lining  the  inner  surfaces  of  the 
lids  and  the  fold  between  the  lids  and  the  eye- 
ball. When  the  lid  is  everted  the  surface  is 
discovered  to  be  rough  and  granular  in  appear- 
ance (whence  is  derived  the  common  name),  and 
this  roughened  surface  soon  causes  an  irritation, 
or  even  an  ulceration,  of  the  delicate  cornea, 
with  consequent  impairment  of  vision.  For- 
tunately, the  disease  is  not  very  common  in  this 
country,  being  practically  limited  to  the  lower 
classes  of  foreign  immigrants,  mainly  the  Rus- 
sian or  Polish  Jews,  and  appears  but  very  rarely 
among  Americans  of  cleanly  habits;  nurses  and 
physicians  sometimes  become  infected,  through 
no  fault  of  their  own,  while  treating  patients 
who  have  the  disease,  but,  otherwise,  true  granu- 
lar lids  are  rarely  observed  except  among  the 
unclean,  poverty-stricken  portion  of  our  tene- 
ment dwellers. 

The  encrusted,  inflamed,  and  roughened  lid 
margins  frequently  seen  and  sometimes  mis- 
takenly spoken  of  as  granulated  lids  are  gener- 
ally not  a  serious  condition,  but  an  annoying  one 
that  produces  a  very  unpleasant  sensation  and 
an  unsightly  appearance.  Examination  of  such 
eyes  usually  shows  an  error  of  refraction,  and 


PINK-EYE.  51 

the  wearing  of  correcting  glasses  cures  the  lid 
trouble. 

STYES. 

Styes  are  localized  abscesses  of  the  lid 
margin.  They  are  caused  by  germs  gaining 
entrance  to  the  little  openings  of  the  small  gland- 
ducts  around  the  hairs  or  lashes  and  causing  a 
purulent  inflammation.  A  local  swelling  with 
redness  and  pain  results,  pus  is  formed,  and  in 
time  the  stye  bursts  and  discharges  its  contents. 
They  have  a  tendency  to  occur  in  crops,  one 
following  another,  because  such  infective  germs 
are  more  or  less  constantly  present  on  the  skin, 
and  the  fact  that  the  first  one  appeared  means 
that  the  local  resistance  to  infection  is  below 
normal.  As  has  been  stated  elsewhere  (on  page 
27),  this  reduction  of  local  resistance  is  gener- 
ally the  result  of  eye-strain.  Removal  of  the 
cause  prevents  a  succession  of  styes,  and  opening 
the  existing  one,  followed  by  application  of  heat, 
preferably  in  the  form  of  bathing  with  hot  water, 
to  promote  absorption  and  healing,  is  the  quick- 
est way  to  cure  the  affection. 

PINK-EYE  (CONJUNCTIVITIS). 

An  inflammation  of  the  mucous-membrane 
covering  of  the  eye  that  occurs  often  in  epidemic 


52  THE   EYE. 

form.  It  is  an  infection  and  is  easily  spread  in 
schools  or  public  places  where  people  congregate. 
The  technical  name  for  it  is  conjunctivitis,  and 
it  responds  very  promptly  to  proper  treatment, 
but  it  is  not  safe  to  rely  upon  hoine  treatment 
of  any  eye  inflammation.  Its  most  prominent 
symptom  is  redness  of  the  eye,  but,  as  that  is  a 
symptom  that  is  common  to  all  eye  inflamma- 
tions, and  accompanies  such  serious  eye  diseases 
as  iritis  and  glaucoma,  it  is  readily  understood 
that  the  layman  should  not  depend  upon  his  own 
judgment  in  making  the  diagnosis. 

IRITIS  AND  GLAUCOMA. 

Iritis,  as  the  name  implies,  is  an  inflammation 
of  the  iris,  the  colored  part  of  the  eye,  and  in 
addition  to  the  intense  redness  of  the  eye  ob- 
servable it  is  marked  by  considerable  pain.  It 
occurs  frequently  in  association  with  rheumatism 
or  other  blood  disease,  and  unless  promptly 
treated  may  cause  loss  of  sight. 

Glaucoma,  while  not  so  commonly  seen,  is 
yet  not  a  rare  disease.  It  consists  essentially  of 
a  gradual  hardening  of  the  eyeball  and  loss  of 
sight  through  the  consequent  pressure  upon  the 
nerve  of  vision.  It  may  occur  in  either  an  acute 
or  chronic  form,  and  the  former  type  is  accom- 


CATARACTS.  53 

panied  by  most  excruciating  pain.  In  the  acute 
form,  prompt  treatment,  usually  an  operation, 
offers  the  only  hope  of  saving  the  sight.  It 
should  be  needless  to  say  that  a  competent  physi- 
cian should  be  consulted  immediately  for  any 
inflammation  of  the  eyes. 


CATARACTS. 

Cataract  is  the  term  used  to  describe  an 
opaque  lens.  There  are  a  number  of  different 
forms,  as,  for  instance,  the  congenital  cataract,  a 
child  being  born  with  opaque  lenses  or  opaque 
spots  in  the  lens;  traumatic  cataracts,  where  the 
opacity  results  from  an  injury — but  the  word  is 
most  commonly  applied  to  that  condition  known 
as  senile  cataract,  an  opacification  of  the  lens 
occurring  spontaneously  in  elderly  persons.  It 
was  formerly  assumed  that  all  persons  would 
develop  cataracts  provided  they  lived  to  suffi- 
ciently old  age,  but  it  is  now  believed  that  this 
was  a  mistake,  and  that  cataracts  probably  occur 
principally  to  persons  who  have  not  taken  good 
care  of  their  eyes  throughout  early  adult  life. 
Abuse  of  the  eyes  by  overwork  or  failing  to 
correct  ocular  defects  in  time,  by  proper  glasses, 
causes  eye-strain,  and  the  accompanying  or  con- 
sequent interference  with  the  nutrition  of  the 


54  THE    EYE. 

lens  results  in  a  gradual  loss  of  its  transparency. 
The  victim  first  notices  some  difficulty  in  seeing 
small  or  fine  objects  and  a  gradual  loss  of  ability 
to  read  or  to  follow  occupations  requiring  clear 
vision.  The  development  of  a  cataract  may  be 
rapid  or  slow,  and  sometimes  several  years 
intervene  between  the  first  impairment  of  vision 
and  complete  loss  of  sight  or  even  sufficient 
loss  to  enforce  abstention  from  all  close  work. 
Generally  both  eyes  are  involved,  but  one  be- 
comes cloudy  much  sooner  or  more  rapidly  than 
the  other.  It  is  fortunate  that  this  is  so,  for  it 
often  enables  the  patient  to  have  the  worst  eye 
operated  upon  and  its  vision  restored  before  the 
second  eye  requires  treatment.  The  period  at 
which  treatment  is  instituted  has  been  called  the 
time  when  the  cataract  is  "ripe,"  and  may  be 
described  most  simply  as  the  time  when  the 
patient  can  no  longer  see  well  enough  to  count 
fingers  at  arm's  length  or  to  read  ordinary  print. 
The  only  treatment  worthy  of  consideration 
is  surgical;  the  various  advertisements  of  reme- 
dies to  "remove  cataract  without  the  use  of  the 
knife,"  to  "cure  cataract  by  absorption,"  etc.,  are 
utterly  unreliable.  The  opaque  lens  must  be 
removed,  since  it  is  acting  as  an  obstruction  to 
the  passage  of  visual  rays  to  the  retina,  and  this 
can  only  be  done  by  making  an  incision  in  the 


CATARACTS.  55 

cornea  and  taking  the  lens  out.  The  operation 
is,  naturally,  a  delicate  one,  requiring  marked 
skill  on  the  part  of  the  operator,  but  to  the 
patient  it  is  a  comparatively  trivial  experience. 
The  discovery  of  cocaine  has  rendered  the  opera- 
tion a  painless  one;  it  is  not  necessary,  except 
in  very  rare  cases,  to  take  a  general  anesthetic. 
The  operation  lasts  but  a  few  minutes,  and 
except  for  the  fact  that  the  patient  is  conscious 
of  what  is  going  on  about  him  he  would  not 
know  that  he  was  being  operated  upon.  With 
the  recent  high  development  of  special  surgery 
the  success  of  cataract  operations  has  steadily 
improved  until  now  the  percentage  of  successful 
results  is  more  than  95  per  cent.;  that  is  to  say, 
95  patients,  or  more,  out  of  every  hundred  sub- 
mitted to  cataract  operation  have  good  useful 
vision  restored  to  them.  Considering  these  facts, 
the  word  cataract  has  lost  most  of  its  horror, 
and  those  who  are  so  unfortunate  as  to  be 
afflicted  with  this  affection  may  take  courage 
from  the  fact  that  their  slowly  developing  blind- 
ness need  be  but  a  temporary  affair,  and  that 
they  can  look  forward  to  the  day  of  restoration 
of  sight. 


56  THE    EYE. 

TOBACCO  AND  ALCOHOLIC  BLINDNESS. 

The  excessive  use  of  alcoholic  stimulants  and 
of  tobacco  affects  the  eye,  as  it  may  every  other 
organ  of  the  body.  It  is  to  be  borne  in  mind 
that  what  is  excessive  for  one  is  not  for  another, 
and  that,  while  some  men  use  large  quantities  of 
these  substances  without  apparent  injury,  others 
may  find  even  one  cigar  a  day  too  many.  The 
injurious  effect  of  tobacco  is  noticed  in  the  eye 
by  a  peculiar  and  characteristic  lesion  of  the 
optic  nerve  that  results,  eventually,  in  atrophy 
of  the  nerve  structure  and  consequent  destruc- 
tion of  its  function.  As  the  nerve-fibers,  one 
after  another,  are  destroyed,  visual  power  grad- 
ually disappears  until  absolute  blindness  super- 
venes, upon  complete  destruction  of  the  nerve. 

For  some  people,  then,  tobacco  is  a  poison; 
and  since  no  one  can  determine  who  will  be  one 
of  these  susceptible  individuals,  a  safe  course  will 
be  to  use  it  only  in  moderation  and,  should  any 
visual  defect  appear,  cease  its  use  immediately. 
By  proper  treatment,  instituted  early,  and  total 
abstention  from  use  of  the  harmful  substances, 
the  disease  can  be  checked  and  further  loss  of 
vision  than  that  noted  at  the  time  the  patient 
comes  under  observation  can  be  prevented. 
Tobacco  alone  rarely,  if  ever,  produces  any 


POSSIBLE  EYE  DISORDERS.  57 

poisonous  effect  upon  the  nerve  of  sight;  almost 
all  of  the  cases  observed  have  occurred  in 
persons  who  are  addicted  to  alcoholic  stimulants 
as  well  as  to  the  use  of  tobacco.  Regarding  the 
different  ways  of  using  tobacco,  considered  from 
the  standpoint  of  their  relative  danger  to  the 
eyes,  it  may  be  said  that  pipe  smoking  is  probably 
the  most  dangerous ;  after  chewing  or  the  use  of 
snuff,  cigar  smoking  is  next  on  the  list,  and  the 
much-discussed  cigarette  the  least  dangerous  of 
all. 

SUBJECTIVE    SENSATIONS    THAT    SHOULD    CALL 
ATTENTION  TO  POSSIBLE  EYE  DISORDERS. 

Headaches. — We  have  already  emphasized 
the  fact  that  headache  is  more  commonly  caused 
by  eye-strain  than  by  any  other  single  thing. 
The  headache  produced  by  defective  eyes  has  no 
characteristic  form:  it  may  be  mild  or  severe; 
felt  only  on  use  of  the  eyes  or  felt  at  some  time 
after  their  use ;  be  limited  to  the  eyes  or  the  brow, 
or  extend  over  the  entire  cranium;  may  be 
practically  constant  or  may  recur  at  irregular 
intervals.  The  point  for  the  layman  to  bear  in 
mind  is  that  frequent  occurrence  of  headache 
demands  an  examination  of  the  eyes  by  a  com- 
petent oculist,  and  that  it  is  much  better  to  have 
such  an  investigation  made  early  or  even  need- 


58  THE   EYE. 

lessly,  as  it  may  appear  to  him,  should  no  re- 
fractive error  be  discovered,  than  to  dose  himself 
or  to  be  dosed  with  drugs  for  the  relief  of  pain 
that  might  be  obviated  by  proper  care  of  the 
eyes. 

Eye-pain. — Distinct  pain  in  the  eye,  other 
than  that  spoken  of  as  headache,  usually  occurs 
in  connection  with  some  inflammatory  condition. 
The  most  common  inflammation  is  conjuncti- 
vitis, in  which  the  pain  is  of  a  smarting  or  sting- 
ing character,  and  accompanied  by  redness  of 
the  eye  and  an  excessive  flow  of  tears.  When 
the  pain  is  of  a  more  severe  nature  there  is 
usually  an  affection  of  greater  severity,  as  iritis 
or  glaucoma.  The  degree  of  pain  cannot,  how- 
ever, be  depended  upon  as  a  guide  to  the  serious- 
ness of  the  disease,  since  some  persons  are  less 
sensitive  to  suffering  than  are  others.  Any  pain 
in  the  eye  requires  an  investigation. 

Flashes  of  Light  or  Rainbows. — The  sensa- 
tion of  light  flashes  or  the  appearance  of  colored 
rings  and  rainbow  colors  about  the  gas  or  lamp 
lights  is  strong  evidence  of  serious  intraocular 
disease.  The  latter  symptom,  particularly,  is 
often  the  first  indication  of  glaucoma,  and  as  that 
disease  in  its  chronic  form  is  one  of  insidious 
onset  and  development  it  is  important  that  ad- 


POSSIBLE  EYE  DISORDERS.  59 

vantage  should  be  taken  of  this  early  symptom 
that  proper  treatment  may  be  secured. 

Tear  Drop. — A  flow  of  tears,  especially  on 
exposure  to  cold  weather  or  on  windy  days,  is 
generally  a  symptom  of  obstruction  of  the  chan- 
nel through  which  the  tears  ordinarily  escape. 
Under  normal  conditions  the  tears  enter  a  little 
canal  in  the  lids  and  flow  through  the  tear-duct 
into  the  nose.  Any  obstruction  to  this  duct  pre- 
vents outflow  of  tears  in  the  natural  way  and 
while  in  a  warm  atmosphere  the  tears  may  be 
removed  from  the  eye  by  evaporation;  on  cold 
days,  when  evaporation  cannot  readily  occur,  the 
excess  of  tears  flows  over  the  lid  margin  onto 
the  cheek.  In  the  beginning  of  such  a  condition, 
it  may  be  easy  to  overcome  the  obstruction  and 
restore  the  natural  channel  or  to  remove  the  irri- 
tant that  is  producing  an  excess  of  tears.  If 
neglected,  the  condition  is  prone  to  become  much 
more  serious,  the  tears  that  are  retained  in  the 
tear-duct  or  sac  becoming  infected  and  thereby 
producing  an  abscess  that  discharges  backward 
through  the  small  opening  in  the  lids  or,  in  some 
cases,  ruptures  through  the  skin  and  forms  an 
unsightly  and  disagreeable  fistula  upon  the 
cheek.  After  such  an  inflammatory  condition 
has  been  permitted  to  arise  the  treatment  is, 
naturally,  more  difficult  and  oftentimes  taxes  the 


60  THE   EYE. 

skill  of  even  an  expert  eye  specialist.  Practi- 
cally all  cases  can  be  cured,  but  surgical  measures 
will  have  to  be  resorted  to  except  in  the  early 
stages  of  the  disease. 

Spots  Before  the  Eyes. — The  appearance  of 
black  spots,  ''flies,"  "cobwebs,"  etc.,  may  indi- 
cate some  disease  inside  the  eyes  or  the  less 
dangerous  condition  of  eye-strain.  They  occur 
quite  frequently  with  the  latter  condition,  and 
may  be  taken  as  a  warning  that  an  examination 
of  the  eyes  is  necessary.  Those  spots  occurring 
with  inflammations  of  the  eye  are  usually  more 
dense  in  character  and  are  accompanied  by  other 
symptoms  which  force  the  patient  to  seek  treat- 
ment. Whenever  spots  appear  in  the  visual  field 
they  may  be  considered  as  abnormal  and  demand- 
ing attention. 

HOW  TO  MAKE  APPLICATIONS  TO  THE  EYES. 

Remedies  prescribed  for  use  in  affections  of 
the  eyes  are  generally  ordered  in  the  form  of 
drops  or  salves,  sometimes  an  eye-bath  or  a  lotion 
is  used,  and  occasionally  one  may  be  called  upon 
to  apply  a  bandage.  It  would  seem  to  be  an 
easy  matter  to  apply  drops  to  an  eye,  and  yet 
there  is  a  right  and  a  wrong  way  to  proceed,  and, 
while  the  right  way  is  easy  and  causes  no  discom- 


HOW  TO  MAKE  APPLICATIONS.  61 

fort,  the  wrong  way  may  produce  a  great  deal 
of  discomfort  and  sometimes  an  injury.  It  is 
the  common  practice  now  with  pharmacists  to 
supply  a  medicine  dropper  with  all  solutions  that 
are  to  be  dropped  upon  the  eye.  The  first  pre- 
caution in  the  use  of  such  a  dropper  to  be  ob- 
served is  that  the  instrument  should  never  be 
inverted  after  the  solution  has  been  drawn  into 
the  glass  tube;  if  the  dropper  is  held  writh  the 
rubber  end  downward  and  the  fluid  allowed  to 
run  into  the  rubber  and  then  back  into  the  glass 
portion  it  will  be  noticed  that  the  solution  is  no 
longer  clear,  but  contains  fine  particles  of  powder 
that  have  been  washed  off  the  rubber.  This  fine 
dust  may  prove  irritating  to  the  eye,  and  such  a 
procedure  has  spoiled  the  drops.  Hold  the 
dropper  gently  by  its  soft-rubber  end,  squeeze 
the  rubber,  insert  the  glass  tip  into  the  bottle  and, 
relaxing  pressure  upon  the  bulb,  suck  up  a  few 
drops  of  the  solution ;  it  is  not  necessary  to  draw 
up  a  whole  tubeful,  as  one  or  two  drops  for  each 
eye  are  all  that  are  ever  required.  Keep  the 
dropper  in  an  upright  position,  rubber  end  al- 
ways up,  without  squeezing  the  bulb  until  it  is 
desired  to  eject  the  drops  upon  the  eye,  when 
gentle  pressure  will  release  the  fluid  one  drop  at 
a  time. 

The    second    important    point    is    never    to 


62  THE    EYE. 

drop  the  fluid  directly  on  the  cornea — unless  in- 
structed by  the  physician  to  so  do — because  that 
is  the  most  sensitive  portion  of  the  eye,  and  even 
a  drop  of  water  falling  upon  it  will  give  pain. 
The  application  of  drops  can  be  made  without 
any  pain  whatever  by  the  very  simple  device  of 
drawing  the  lower  lid  down  and  placing  a  drop 
on  the  exposed  inner  surface  thereof,  as  shown 
in  the  accompanying  illustration.  (Fig.  2.) 
When  the  lid  is  released  the  drop  immediately 
spreads  itself  over  the  surface  of  the  eye.  You 
may  even  touch  the  inner  surface  of  the  lower 
lid  with  the  dropper  or  the  finger  without  causing 
discomfort,  whereas  the  slightest  drop  upon  the 
eyeball  produces  pain.  One  drop  in  the  eye,  or 
two  at  most,  is  quite  sufficient,  and  anything  in 
excess  of  that  is  wasted  because  it  flows  into  the 
tear-duct  or  over  upon  the  cheek. 

Applications  of  ointment  may  be  made  in 
much  the  same  way;  the  salve  being  taken  up  on 
a  cotton-tipped  toothpick,  for  instance,  and  wiped 
off  on  to  the  everted  lower  lid. 

There  is  a  very  prevalent  belief  that  a  daily 
cold  bath  of  the  eyes  (opening  and  shutting  the 
eyes  under  water)  is  beneficial  and  tends  to 
strengthen  them.  It  may  render  the  eyes  more 
resistant  to  external  influences,  such  as  cold,  but 
it  could  not  in  any  way  affect  the  sight,  and 


W  -tJ/J 


Fig.  2. — Proper  method  of  applying  drops 
to  the  eyes. 


HOW  TO  MAKE  APPLICATIONS.  63 

while  it  may  do  no  harm  it  does  practically  no 
good.  As  a  medical  measure  in  certain  inflam- 
matory conditions  of  the  eye,  bathing  of  the  eyes 
with  cold  or  with  hot  water  may  be  required. 
There  are  several  ways  of  doing  this.  One  may 
apply  the  water  simply  with  the  hands,  as  in  the 
act  of  washing  the  face,  or  with  the  aid  of  a 
sponge  or  soft  linen  cloth.  Again,  there  is  a 
special  "eye  cup"  made  for  the  purpose;  a  small 
oval-shaped  glass  bowl  with  concave  margins 
that  can  be  filled  with  water  and  held  to  the 
eye,  fitting  neatly  over  the  upper  and  lower 
lids,  so  that  the  eye  is  immersed  in  the  fluid.  No 
special  apparatus  is  necessary,  however,  and  the 
simpler  means  described  above  are  quite  effi- 
cient. Another  means  of  applying  cold  or  heat 
to  the  eye  is  to  cut  small  round  disks  of  soft  linen 
and,  using  several  of  these  together,  so  as  to 
make  a  fairly  thick  pad,  lay  them  on  a  piece  of 
ice,  or  wring  them  out  of  hot  water,  and  apply  the 
pad  over  the  closed  eyelids;  as  fast  as  the  cold 
pad  becomes  warm  (or  the  hot  one  cools  off,  if 
heat  is  being  employed),  it  can  be  changed  for 
another  that  has  been  in  preparation. 

Lotions,  of  whatsoever  character  prescribed, 
are  to  be  applied  in  the  same  way,  similar  pads 
being  soaked  with  the  medicine. 

Bandages. — In  an  emergency,  a  handkerchief 


64  THE    EYE. 

may  be  folded  into  a  narrow  band,  the  central 
portion  of  which  is  placed  over  the  affected  eye, 
and  the  ends  tied  at  the  back  of  the  head.  Where 
it  is  necessary  to  keep  the  eye  bandaged  for  any 
length  of  time,  or  to  remove  and  replace  the 
bandage  frequently,  some  device  less  bulky  and 
more  convenient  is  desirable.  One  of  the 
simplest  methods  is  to  prepare  a  small  pad  like 
that  described  above,  or  a  pad  composed  of  a 
layer  of  cotton  between  two  small  disks  of  gauze, 
and  to  maintain  this  in  position  over  the  closed 
eye  by  the  aid  of  two  strips  of  narrow  adhesive 
plaster,  crossing  each  other,  carried  from  the 
forehead  to  the  .cheek.  Still  another  form  of 
bandage  easy  to  make  consists  of  a  square  of 
linen,  about  two  and  one-half  by  two  and  one- 
half  inches,  to  each  corner  of  which  a  piece  of 
tape  is  attached;  this  is  called  the  four-tailed 
bandage  and  the  tape  ends  are  to  be  tied  behind 
the  head. 


II, 

THE  EAR. 


THE  question  may  fairly  be  asked,  How  many 
of  our  readers  have  ever  given  the  slightest  con- 
sideration to  their  ears,  really  one  of  their  most 
valuable  possessions?  If  you  have  ever  thought 
of  it  at  all  you  have  probably  considered  the  ear 
merely  as  one  of  the  special  sense  organs  that 
functions  automatically  and  which  you  would 
miss  seriously  should  disease  deprive  you  of  its 
use.  But  did  it  ever  occur  to  you  that  the  ear  is 
the  most  remarkable  and  the  most  delicate,  if  not 
the  most  important,  of  these  special  sense 
organs  ;rthat  the  mechanism  of  the  hearing  ap- 
paratus is  one  of  the  marvels  of  nature;  that  its 
importance  in  the  human  economy  is  so  great 
that  nature  has  endeavored  to  guard  and  protect 
it  better  than  any  of  the  other  special  senses  ;u 
that,  while  consisting  of  the  most  delicately  co1fi> 
structed  and  perfectly  adjusted  mechanical  ar- 
rangement in  the  body,  it  performs  its  physio- 
logical functions  with  the  slightest  possible 
intrusion  upon  the  individual's  life  and  the  least 
tax  upon  his  energy  and  strength?  Let  us 

os  (65) 


66  THE  EAR. 

consider  some  of  these  points  briefly  in  order 
better  to  understand  how  the  normal  function  of 
the  ear  may  be  interfered  with  and  how  we  can 
best  preserve  or  reclaim  hearing  power. 

The  important  part  which  hearing  plays  in 
our  daily  life  is  appreciated  by  very  few  people. 
Do  you  know  that  the  ear  is  far  more  accurate 
and  truthful  in  its  reports  to  the  brain  than  is 
the  eye?  False  visual  impressions  are  very 
common  indeed,  but  false  hearing  is  very  un- 
usual. How  often  have  you  had  the  experience 
of  failing  to  recognize  an  old  acquaintance  until 
he  spoke  or  laughed;  the  sound  of  his  voice, 
though  not  heard  for  years  perhaps,  recalled  all 
of  the  old  memories  which  sight  alone  could  not 
stir.  Visual  memories  may  be  as  vivid,  at  times 
more  so,  but  they  are  not  so  lasting  as  hearing 
memories.  How  striking  that  advertisement — 
"His  Master's  Voice!"  A  writer  in  one  of  the 
magazines,  Dr.  Thomson,  in  Everybody's 
(March,  1909,  page  353),  calls  attention  also  to 
the  close  relationship  existing  between  the  ear 
and  the  emotions:  "Unlike  the  eye,  which 
chiefly  informs  the  mind,  the  ear  stirs  the  emo- 
tions. We  can  see  a  fish  writhing  in  its  death 
agony  without  pity,  but  no  one  can  so  listen  to 
an  animal's  shrieks  of  pain.  This  is  as  it  should 
be,  for,  however  wrong  the  head,  the  heart 


GENERAL  CONSIDERATIONS.  67 

should  keep  right.     Through  the  ear  the  pro- 
foundest  depths  of  being  are  revealed." 

The  moving  picture  or  the  pantomime  pro- 
duces no  such  effect  upon  our  feelings  as  a 
similar  performance  accompanied  by  dialogue. 
It  is  hearing  a  recital  of  humorous  or  pathetic 
incidents  that  moves  one.  It  is  not  the  sight  of 
the  beggar  nor  the  particular  words  of  his  appeal 
that  reach  the  charitable  chord  in  your  heart;  it 
is  the  mysterious  something  in  his  voice,  that  can 
reach  you  only  through  your  ears,  that  tells  you 
whether  or  not  he  is  honest  and  deserving  of 
help.  When  you  read  the  daily  paper  you  may 
construct  a  mental  vision  of  the  scenes  described 
or  the  controversies  enacted,  but  it  is  the  con- 
jured-up  word-picture,  the  mental  reproduction 
of  things  said,  and  the  inflection  in  tone  with 
which  you  imagine  them  to  have  been  said  that 
makes  the  deepest  impression  upon  you. 

yOf  course,  the  loss  of  any  one  of  our  special 
senses  would  be  a  calamity,  but  if  you  want  a 
fair  idea  of  the  value  of  your  ears  just  try  the 
experiment  of  going  for  one  day  with  the  ears 
closed  by  pledgets  of  cotton  so  as  to  keep  out  all 
sound.  You  will  find  yourselves  in  an  absolutely 
new  world;  a  world  without  sound,  for  it  is  an 
axiom  that  there  is  no  sound  where  there  is  no 
ear  to  hear  it.  This  appears,  at  first  thought, 


68  THE  EAR. 

strange  to  the  untutored  mind,  but  it  is  quite  true. 
The  blow  struck  by  the  woodchopper,  the  explo- 
sion of  a  gun,  or  any  ofcker  sound-producing 
action  is  merely  the  setting  in  motion  of  atmos- 
pheric particles,  f  Suppose  we  place  a  lemon  on  a 
board  and  smack  it  smartly  with  another  piece 
of  wood,  what  happens?  The  lemon  is  squeezed 
to  the  bursting  point  and  its  juice  spurts  out  in 
all  directions.  Suppose  the  two  pieces  of  wood 
had  been  brought  together  in  the  same  manner 
when  nothing  intervened  between  them  but  ai*, 
what  would  have  happened?  -^on  may^answer 
Jtkal  a  sutm4~er  a- noise  would  be  produced.  Not 
exactly ;  the  coming  together  of  the  two  boards 
squeezes  or  compresses  the  intervening  air  and 
it  flows  out  in  all  directions ;  in  other  words,  the 
air  is  set  in  motion.  Now  if  there  is  an  ear 
within  convenient  distance  the  moving  waves  of 
air  reach  it,  touch  the  drum-head,  and  start  it  in 
motion,  and  this  motion  is  transmitted  to  the 
brain%  where  it  makes  an  impression  which  is 
interpreted  as  a  sound^  Up  to  the  moment  of 
perception  by  the  brain  the  only  effect  of  the 
striking  boards  had  been  the  production  of  a 
wave  in  the  atmosphere,  a  form  of  motion  that 
we  call  "sound  waves."  It  is  not  actually  sound 
until  the  ear  and  brain  perceive  it,  and  had 
there  been  no  ear  present  the  wave  would  have 


GENERAL  CONSIDERATIONS.  69 

passed  on  into  space  and  died  out  without 
producing  any  effect  other  than  a  slight  move- 
ment in  the  atmosphere./  Sound  waves  travel 
slowly  and  only  for  short  distances,  in  striking 
contrast  to  light  waves,  which  the  eye  perceives 
and  transmutes  into  sight.  "The  motions  giving 
rise  to  the  sensation  of  light  are  too  minute  to 
originate  the  sensation  of  sound ;  and,  conversely, 
motions  capable  of  producing  sound  are  too 
gross  to  generate  light.  Both  light  and  sound, 
external  to  the  eye  and  ear,  are  only  modes  of 
motion,  but  modes  of  motion  that  require  spe- 
cially adjusted  organs,  and  organs  of  different 
degrees  of  sensitiveness,  for  their  transmutation 
into  the  sensations  of  light  and  sound.  The  kind 
of  motion  that  is  competent  to  stimulate  the  optic 
nerve  has  no  effect  whatever  upon  the  auditory 
nerve.  We  cannot  see  a  sound  and  we  cannot 
hear  a  color." 

A  few  words  may  be  given  to  the  varying 
character  of  sounds.  Sound  waves  that  have  a 
regular,  rhythmical  motion  produce  sounds 
which  we  call  musical ;  and  irregular,  non-period- 
ical movements  give  rise  to  sound  sensations 
known  as  noises.  With  such  a  variety  of  sound 
waves  as  it  is  possible  to  produce  in  the  world 
it  is  not  surprising  that  it  is  sometimes  difficult 
to  draw  a  sharp  distinction  as  to  what  is  or  is 


70  THE  EAR. 

not  musical ;  not  all  noises  are  unmusical  and  not 
all  so-called  music  is  pure.  The  ear  that  is 
trained  to  distinguish  to  a  nicety  the  little  differ- 
ences in  sounds  finds  for  its  possessor  many 
delights  in  nature  that  the  ordinary  unobservant 
person  misses,  and  we  could  all  profit  immeasur- 
ably by  cultivating  the  faculty  of  hearing.  Byron 
expresses  this  idea  elegantly,  when  he  sings : — 

"There's  music  in  the  sighing  of  a  reed; 
There's  music  in  the  gushing  of  a  rill ; 
There's  music  in  all  things  if  men  had  ears, — 
Their  earth  is  but  an  echo  of  the  spheres." 

Now,  thinking  of  our  ears  as  mechanical  in- 
struments for  the  reception  and  transmutation 
of  sound  waves  into  sensations  of  sound,  we  find 
that  we  are  dealing  with  a  very  mysterious  piece 
of  mechanism.  In  the  first  place,  there  is  the 
external  ear,  called  the  auricle  and  external 
auditory  canal,  for  the  collection  of  these  sound 
wraves.  At  the  inner  end  of  this  canal,  and  clos- 
ing it  over,  is  the  drum-head  which  receives  the 
impact  of  the  collected  sound  waves.  All  of  this 
constitutes  what  is  called  the  receptive  portion 
of  the  hearing  apparatus.  Just  internal  to  this 
is  the  drum  proper,  and  in  this  cavity  are  sus- 
pended three  small  bones,  called  the  auditory 
ossicles.  The  outermost  one,  the  malleus,  or 


GENERAL  CONSIDERATIONS.  71 

hammer,  has  its  long  process  or  handle  attached 
to  the  head  of  the  drum;  the  middle  one,  called 
the  incus,  or  anvil,  is  attached  to  the  head  of  the 
hammer  on  one  side  and  on  the  other  to  the  head 
of  the  stapes,  or  stirrup;  the  stirrup,  the  inner- 
most member  of  the  group,  is  in  turn  attached 
by  its  foot-plate  to  an  opening  in  the  inner  wall 
of  the  drum,  where  it  comes  into  contact  with  the 
special  end  apparatus  of  the  nerve  of  hearing. 
Within  the  drum  are  also  two  small  muscles  to 
control  the  movements  of  these  bones,  and  the 
entire  drum,  or  middle  portion  of  the  ear,  is  called 
the  transmitting  apparatus  because  its  principal 
function  is  to  transmit  to  the  internal  ear  the 
sound  waves  that  have  been  received  by  the  ex- 
ternal ear,  or  receptive  portion.  Now,  the  inter- 
nal ear,  the  so-called  perceptive  apparatus, 
consists  of  a  finely  developed  nerve-fiber  sub- 
stance of  the  auditory  nerve,  or  nerve  of  hearing, 
buried  in  a  bony-walled  receptacle  deep  in  the 
head.  This  cavity  is  filled  with  fluid,  and  floating 
therein  is  this  mass  of  nerve-fibers,  the  terminals 
of  the  auditory  nerve,  of  different  lengths  and 
arranged  in  a  spiral  form  so  that  there  is  a 
gradual  increase  in  the  length  of  fibers  from  one 
end  of  the  spiral  to  the  other.  It  will  be  impor- 
tant to  remember  that  the  drum  of  the  ear  is 
essentially  an  air  chamber,  and  that  it  is  con- 


72  THE  EAR. 

nected  with  the  throat  by  a  special  tube  so  that 
there  can  be  a  regular  and  constant  replenish- 
ment of  air  as  needed.  Having  described  what 
constitutes  a  sound  wave  and  the  machinery  for 
utilizing  it,  let  us  consider  what  takes  place  in 
the  production  of  a  sound,  i 

The  atmosphere  having  been  set  in  motion 
and  the  sound  wave  being  received  into  the  canal 
of  the  ear,  it  impinges  upon  the  drum-head  and 
sets  in  motion  the  first  ossicle,  the  hammer,  which 
strikes  upon  the  second,  the  anvil,  and  that,  in 
turn,  transmits  the  force  to  the  third,  the  stirrup, 
from  the  foot-plate  of  which  the  motion  is  trans- 
mitted to  the  fluid  of  the  internal  ear,  where  it 
starts  a  wave-like  motion  that  spreads  until  the 
hair-like  nerve-fiber  which  corresponds  in  length 
to  that  wave  of  fluid  is  struck  and  the  impression 
is  conveyed  by  the  nerve-fiber  to  the  brain,  and 
the  motion  is  translated  into  sound.  A  com- 
plicated piece  of  machinery,  you  say.  Yes,  even 
more  so  than  would  appear  from  this  description, 
for  we  have  endeavored  to  express  the  action  in 
the  -simplest  possible  terms,  but  its  very  com- 
plication makes  it  an  instrument  of  precision,  an 
instrument  so  delicately '.constructed  that  it 
enables  us  to  hear  a  great  variety  of  sounds — 
even  to  appreciate,  as  musical,  sounds  that  are 
as  yet  far  beyond  the  power  of  any  humanly 


MALFORMATIONS.  73 

devised  musical  instrument  to  produce.  Our 
range  of  hearing  for  musical  sounds  alone  covers 
eleven  octaves,  while  the  largest  organ  never  has 
more  than  eight  octaves,  the  piano,  as  usually 
constructed,  embraces  from  seven  to  seven  and 
one-half  octaves,  and  the  violin  has  but  three 
and  one-half  octaves ;  as  a  matter  of  fact,  neither 
the  highest  nor  the  lowest  octaves  of  the  organ 
or  piano  are  much  used,  so  their  practical  range 
is  only  about  five  octaves. 

Very  naturally,  an  instrument  of  such  delicate 
structure  as  the  human  ear  presents  many  oppor- 
tunities for  getting  out  of  order, 'even  though  it 
is  so  well  protected  by  having  been  placed  within 
the  heavy  bony  walls  of  the  cranium.  The  ex- 
ternal portion  of  the  ear  is  subject  to  possible 
accidents,  to  injuries  which  may  not  only  cause 
deformity,  but  may  so  distort  the  auricles  as  to 
interfere  with  its  function  of  collecting  sound 
waves  or  that  may  cause  obstruction  to  the  ad- 
mission of  these  waves  into  the  canal. 

MALFORMATIONS. 

There  is  such  a  thing  as  congenital  malfor- 
mation of  the  ears,  that  is,  there  may  be  only  a 
distorted  bit  of  cartilage  more  or  less  resembling 
the  natural  ear,  or  there  may  be  several  of  these 


74  THE  EAR. 

little  tubercles,  in  addition  to  the  normal  ear,  the 
so-called  supernumerary  auricles.  Malposition 
of  the  ear  is  more  common  than  malformation; 
the  ear  may  lie  flat  against  the  side  of  the  head 
or,  more  commonly,  may  flare  out  at  right  angles 
thereto.  This  condition  of  sail-like  ear  is  more 
common  in  boys  than  in  girls,  and  possibly  is  due, 
in  some  measure  at  least,  to  the  boyish  habit  of 
drawing  the  hat  or  cap  so  far  down  as  to  force 
the  ears  away  from  the  head.  When  there  is  a 
natural  tendency  to  flaring  of  the  ears  in  early 
childhood  it  can  sometimes  be  prevented  by  the 
regular  wearing  of  a  nightcap  or  bandage,  but 
when  firmly  established  or  in  adult  life  such  ears 
can  be  corrected  only  by  an  operation. 

FOREIGN  BODIES  IN  THE  EAR. 

Anything  which  interferes  with  sound  waves 
reaching  the  drum-head  will,  of  course,  reduce 
the  hearing  power.  Children  not  infrequently 
introduce  foreign  bodies  into  the  ear.  Little" 
Johnny  has  reached  the  age  where  sleight-of-hand 
begins  to  be  considered  an  accomplishment,  and 
he  proceeds  to  introduce  a  glass  bead  or  a  dried 
green  pea  into  the  ear  and  bring  it  out  his  nose. 
Younger  sister  Mary  proudly  emulates  the 
example  of  her  skillful  brother  and  succeeds  only 


FOREIGN  BODIES  IN  THE  EAR.  75 

in  so  far  as  the  first  part  of  the  trick  is  concerned. 
Perhaps  neither  has  the  courage  to  tell  mother 
what  has  happened,  and  the  foreign  body  may 
remain  in  the  ear  for  many  years,  without  caus- 
ing any  particular  discomfort,  until  a  mass  of 
earwax  accumulates  about  it  t0  'close  the  canal 
and  obstruct  hearing;  I  have  removed  foreign 
bodies  that  had  been  in  the  ear  for  more  than  ten 
years.  A  clean  foreign  body  of  the  mineral  type 
is  not  likely  to  do  harm  in  consequence  of  its  mere 
presence  in  the  ear;  of  course,  important  struc- 
tures like  the  drum-head  may  be  injured  in  the 
act  of  entrance  if  the  substance  entered  under 
force,  or  if  any  foreign  body  reaches  the  depth 
of  the  canal  and  rests  in  contact  with  the  drum- 
head it  is  likely  to  occasion  considerable  discom- 
fort. Vegetable  substances  like  peas  and  beans 
may  swell  and  even  germinate  under  the  influ- 
ence of  the  natural  heat  and  moisture  of  the 
canal,  and  th»s  cause  trouble.  Animate  bodies 
such  as  gnats,  flies,  spiders,  and  bugs  of  various 
kinds  occasionally  find  their  way  into  the  ear, 
and  may  occasion  mucfrdislTess'by  craT\rlffl"gro^ver 
or  fastening  their  tentacles  into  the"  sensitive 
drum-head.  The  practical  thing  for  you  to  re- 
member in  connection  with  the  subject  of  foreign 
bodies  in  the  ear  is  that  more  harm  can  be  done 
by  misdirected  or  unskillful  efforts  to  remove 


76  THE  EAR. 

the  substance  than  is  likely  to  result  from  its 
mere  presence.  Never  attempt  to  remove  a 
foreign  body  from  the  ear  with  instruments;  .and 
among  instruments  I  may  class  that  very  useful 
but  dangerous  implement,  the  hairpin.  The  only 
measure  you  may  employ  with  safety  is  an  ear 
syringe.  If  you  cannot  wash  out  the  foreign 
body  by  frequent  syringings  you  had  better  con- 
sult a  physician ;  it  joften  requires  considerable 
skill  to  remove  a  foreign  body  without  doing 
damage  to  the  ear  itself. 


ACCUMULATION  OF  EARWAX. 

What  has 'been  said  of  foreign  bodies  carried 
into  the  ear  from  without  applies  equally  well  to 
collections  of  wax  in  the  ear.  j^ome  persons  are 
subject  to  accumulations  of  this  wax,  or  cerumen 
as  it  is  technically  called,  a  substance  which 
nature  provides  for  the  purpose  of  catching  and 
holding  particles  of  dust  and  small  foreign  bodies 
which  enter  the  canal,  thus  preventing  their 
reaching  the  drum-head.  'There  are  several  pos- 
sible reasons  for  this  recurrence  in  certain  indi- 
viduals ;  one  may  secrete  more  wax  than  another 
or  for  some  reason  does  not  get  rid  of  that  which 
is  formed.  Its  repeated  accumulation  is  not  a 
sign  of.uncleanliness;  in  fact,  it  more  frequently 


DISEASES  OF  THE  DRUM.  77 

results  from  excessive  efforts  to  keep  the  ears 
clean.  The  employment  of  aurilaves,  toothpicks, 
hairpins,  or  the  moistened  corner  of  a  towel  or 
wash-cloth  is  more  likely  to  push  particles  of  wax 
deeper  into  the  canal  than  to  remove  them. 
Nature  provided  a  fairly  efficient  means  of  dis- 
posing of  the  wax,  and  if  that  fails  one  can  only 
submit  to  the  necessity  of  having  the  secretion 
periodically  removed. 


DISEASES  OF  THE  DRUM  OF  THE  EAR. 

The  middle  <*ar,,pr  drum  cavity,  is  the  portion 
of  the  hearing^  .apparatus  most  frequently  sub- 
jected to  disease.  Through  its-  connection  with 
the  throat  and  nose  there  is  always  the  possibility 
that  an  inflammation  of  the  latter  structures  may 
invade  the  drum  and  produce  an  inflammation  or 
an  abscess  in  the  ear.  Thus  a  common  cold  in 
the  head  or  an  attack  -of  grippe  may  be  accom- 
panied by  or  produce  an  involvement  of  this  part 
of  the  ear.  Chronic  diseased  conditions  in  the 
nose  or  throat,  enlarged  or  infected  tonsils,  or 
adenoids  may  in  the  same  way,  by  direct  exten- 
sion of  the  inflammation  to  the  drum,  produce 
lesions  in  the  hearing  organ.  Really,  about  70 
per  cent,  of  all  ear  diseases  arise  in  just  this  way. 
A  middle-ear  trouble  thus  induced  may  pursue 


78  THE  EAR. 

one  of  two  courses :  it  may  result  in  an  abscess  of 
the  drum  or  it  may  be  less  severe  and  cause  only 
a  mild  inflammation,  without  the  formation  of 
pus,  a  condition  often  called  catarrh  of  the  ear. 
Either  condition  is  more  or  less  serious  to  the 
function  of  the  organ. 

In  the  case  of  an  abscess  you  have  some 
destruction  of  tissue  and  the  danger  of  extension 
^  the  brain  cavity,  possibly  giving  rise  to 
meningitis,  brain  abscess,  or  involvement  of  the 
upper  end  of  the  large  jugular  vein,  spreading 
the  infection  to  all  parts  of  the  body,  through 
the  general  circulation.  Any  of  these  complica- 
tions may  result  in  death  unless  an  operation  can 
be  promptly  performed.  The  less  serious  cases 
show  no  such  immediate  complications,  but  sub- 
side after  a  few  days  or  weeks  of  discharging 
pus  from  the  canal,  or  become  chronic  and  con- 
tinue indefinitely  to  discharge  such  matter.  Now, 
this  latter  group  of  cases  is  much  more  serious 
than  the  public  understands.  It  is  unfortunate 
that  in  some  localities  there  is  a  notion  that  a 
running  ear  is  of  no  consequence  and  that  any 
effort  to  suppress  the  discharge  will  result  in 
trouble, — that  the  "discharge  will  break  out  else- 
where." There  is  absolutely  no  substantial  basis 
for  such  a  belief.  It  seems  to  have  been  con- 
structed on  the  idea  that  a  running  ear  indicated 


DISEASES  OF  THE  DRUM.  79 

the  presence  of  an  objectionable  humor  in  the 
body  requiring  an  outlet.  Well,  in  the  first  place, 
the  ear  is  not  a  sewer  for  the  rest  of  the  body, 
and,  in  the  second  place,  the  deductions  as  to  the 
nature  of  the  discharge  are  absolutely  false. '  Pus 
running  from  the  ear  is  an  indication  of  a  purely 
local  disease,  a  chronic  abscess  of  the  drum. 
There  is  no  danger  in  stopping  it,  but  great 
danger  in  permitting  it  to  continue.  So  long  as 
it  is  allowed  to  persist  it  is  a  constant  source  of 
possible  danger.  There  are  numerous  instances 
of  persons  having  had  running  ears  for  many 
years,  even  as  long  as  fifty  years,  without  any 
other  trouble  than  the  annoyance  occasioned  by 
the  discharge  itself,  but,  on  the  other  hand,  medi- 
cal records  are  literally  filled  with  instances  of 
neglected  running  ears  that.  ( suddenly  set  up 
trouble  by  extension  of  the  disease  to  the  brain 
and  caused  death  before  the  surgeon  could  insti- 
tute treatment  or  in  spite  of  his  best  efforts  to 
eradicate  the  disease  at  that  late  hour.  It  is 
known  to  all  experts  in  the  matter  that  a  run- 
ning ear  is  a  constant  menace  to  the  life  of  the 
person  having  it,  and  that  there  is  never  a  day 
when  it  may  not  suddenly  flare  up  and  cause 
serious  trouble. 

Perhaps  you  may  think  the  medical  man  takes 
such  a  view  because  he  is  an  interested  party.    I 


80  THE  EAR. 

can  understand  that  to  be  a  natural  thought, 
though  a  very  unjust  one  to  my  profession.  Let 
me  place  the  situation  before  you  in  another  way. 
You  all  have  great  respect  for  the  business  man's 
view  of  things,  especially  when  he  is  risking 
money  on  his  opinion.  Well,  do  you  know  that 
no  reputable  life-insurance  company  will  assume 
a  risk  on  the  life  of  a  person  who  has  or  recently 
has  had  a  running  ear  ?  That  tells  the  tale  better 
than  anything  a  physician  can  say  to  you.  Do 
not  misunderstand  me  regarding  the  character 
of  the  disease.  Running  ears  are  serious  and 
dangerous,  but  the  danger  lies  chiefly  in  neglect 
of  them.  Practically  every  running  ear  is  sus- 
ceptible of  cure  by  one  form  of  treatment  or 
another,  and  no  one  should  be  permitted  to  go 
without  treatment  under  the  mistaken  notion 
that  his  affection  is  a  trivial  one. 


"CATARRH"  OF  THE  EAR. 

To  revert  to  a  consideration  of  the  second 
type  of  middle-ear  inflammation,  the  catarrhal 
affection,  we  find  here  no  great  risk  to  life,  but 
.the  products  of  such  an  inflammation  impair  the 
motility  of  the  ossicles  and  drum-head  and,  con- 
sequently, diminish  the  hearing  ability;  further- 
more, such  changes  are  apt  to  be  of  a  chronic 


CATARRH  OF  THE  EAR.  81 

character  and,  once  started,  the  ear  continues  to 
deteriorate  unless  the  original  exciting  cause  is 
removed.  A  large  majority  of  this  group  of  ear 
affections  might  be  prevented  by  early  and  proper 
attention  to  the  predisposing  factors.  Many  of 
the  abscesses  and  nearly  all  of  the  so-called 
catarrhal  affections  of  the  ear,  as  I  have  said, 
occur  to  persons  suffering  with  adenoids  or  dis- 
eased tonsils.  The  history  of  such  cases  usually 
is  that  the  child  is  a  mouth-breather  and  snores 
in  his  sleep ;  he  has  occasional  attacks  of  earache, 
the  pain  varying  in  severity  but  always  subsiding 
after  a  short  time,  with  or  without  treatment; 
repeated  attacks  occur  and,  finally,  the  parents 
notice  that  he  does  not  respond  when  spoken  to, 
or  that  what  they  considered  a  slight  degree  of 
deafness  is  increasing.  In  the  case  of  an  adult 
the  picture  is  somewhat  different ;  often  the  deaf- 
ness creeps  on  insidiously  after  a  series  of  head 
colds  or  in  association  with  an  apparently  inno- 
cent but  persistent  nasal  catarrh.  If  your  child 
is  having  repeated  attacks  of  earache  there  is 
almost  surely  an  adenoid  growth  in  his  throat 
or  enlarged  tonsils,  and  the  sooner  you  have 
either  of  these  abnormal  growths  properly  re- 
moved the  more  certain  will  you  be  able  to  prevent 
injury  to  his  hearing.  Medicine  will  do  little 
good;  a  thorough  and  complete  operation  is  re- 


82  THE  EAR. 

quired  and   should  be  performed  only  by  one 
especially  skilled  in  this  branch  of  surgery. 


NERVE  DEAFNESS  AND  DEAF-MUTISM. 

Diseases  of  the  deeper  portion  of  the 
need— ba^eljr^nientlon.  The  nerve f,  may  become 
involved  by  extonmonof  one  of  the  middle-ear 
diseases  of  which  I  have  spoken,  or  it  may  be 
affected  "I5y  "•$y51«mie-trr  hereditary  influences. 
Most  of  these  conditions  cannot  be  forseen,  and 
are  therefore  not  preventable.  Their  considera- 
tion belongs  rather  to  a  medical  convention  than 
to  a  public  discourse.  A  child  born  deaf  will  not 
attempt  to  talk,  because  we  acquire  speech 
through  repeating  what  we  hear.  If  a  young 
child  becomes  deaf  as  the  result  of  disease  he 
will  cease  to  talk,  even  dropping  so  much  of  the 
art  as  he  had  acquired.  These  two  classes  con- 
stitute our  deaf-mutes.  Deaf-mutes  brought 
under  instruction  at  the  proper  time  may  learn  to 
speak,  certainly  may  be  taught  to  understand  the 
language  of  others,  by  reading  the  lip  move- 
ments, and  to  talk,  if  not  orally,  at  least  with 
their  fingers  and  hands;  thus  growing  up  into 
useful,  self-supporting  members  of  the  com- 
munity. 

A  very  considerable  percentage  of  the  chil- 


NERVE  DEAFNESS  AND  DEAF-MUTISM.         83 

W" 

dren  classified  as  "deaf-mutes"  are  found,  on 
careful  examination,  not  to  be  totally  deaf.  If  a 
child  is  partially  but  not  absolutely  deaf,  his  hear- 
ing should  be  accurately  measured  and  then 
developed  by  training,  making  use  of  mechanical 
devices  whenever  such  afford  real  assistance,  to 
improve  the  function  and  enable  him  to  employ 
to  the  fullest  extent  his  fragment  of  hearing 
power.  Before  placing  such  a  child  in  any  school 
or  under  any  form  of  instruction,  it  would  be  wise 
to  have  a  careful  investigation  of  the  ears,  nose, 
and  throat  by  an  expert  and,  if  abnormalities 
such  as  adenoids,  diseased  tonsils,  or  obstructing 
growths  in  the  nose  (conditions  that  might  affect 
the  physiological  function  of  the  ear)  be  found, 
or  if  there  exists  any  inflammatory  affection  of 
the  ears,  the  proper  corrective  treatment  should 
be  instituted.  Later,  having  removed,  as  far  as 
possible,  those  factors  which  could  cause  further 
trouble  or  might,  at  least,  interfere  with  develop- 
ment of  the  organ,  educational  measures  may  be 
employed  with  greater  assurance  of  benefit. 

It  is  to  be  hoped  that  in  this  short  discourse 
we  may  have  succeeded  in  calling  your  attention 
to  the  importance  of  the  organ  of  hearing,  to  the 
necessity  for  preserving  it  in  good  order,  and  to 
the  fact  that  most  of  its  diseases  could  be  pre- 
vented or  cured  by  a  little  judicious  care  at  the 


84  THE  EAR. 

right  time.  As  it  is  sometimes  easier  to  tell 
people  what  not  to  do  than  to  lay  down  specific 
rules  for  positive  guidance,  let  us  conclude  with  a 
few  "Don'ts":— 

Don't  permit  your  boy  to  drag  his  cap  down 
on  his  head  in  such  a  way  as  to  force  his  ears 
forward  into  false  position;  the  deformity  pro- 
duced is  unsightly  and  will  not  enhance  his  beauty 
nor  improve  his  chances  with  the  girls  when  he 
enters  the  social  whirl. 

Don't  pick  your  ears  with  hairpins,  tooth- 
picks or  ear-spoons,  and  don't  try  to  see  how  far 
you  can  insert  the  end  of  a  wash-cloth  or  towel; 
be  satisfied  with  cleansing  so  much  of  the  ear  as 
you  can  see  or  feel  with  the  finger,  depending  on 
nature  to  look  after  the  deeper  parts. 

Don't  try  to  remove  wax  or  any  foreign  body 
from  your  own  or  anyone's  ear  with  forceps  or 
any  of  the  above-named  implements;  if  you  be- 
lieve there  is  a  foreign  body  in  the  ear  and  you 
cannot  remove  it  by  gentle  syringing,  you  had 
better  consult  a  competent  physician. 

Don't  neglect  a  child's  complaint  of  repeated 
earaches  nor  delude  yourself  into  the  notion  that 
his  failure  to  respond  to  questions  or  to  partici- 
pate in  conversation  is  due  to  lack  of  attention; 
when  a  child  is  apparently  hard  of  hearing  or 
complains  of  occasional  pains  in  the  ear  it  is  time 
to  have  the  ears,  nose,  and  throat  examined. 


NERVE  DEAFNESS  AND  DEAF-MUTISM.          85 

Don't  imagine  that  a  running-  ear  is  a  trivial 
affection;  it  is  always  a  serious  affair  and  some- 
times an  extremely  dangerous  one;  proper  care 
of  running  ears  nearly  always  results  in  cure, 
while  neglect  of  such  conditions  frequently  re- 
sults in  an  early  death. 

Don't  ignore  or  neglect  a  failing  ear,  one 
that  is  simply  becoming  progressively  deafer,, 
because  the  newspaper  advertisements  of  patent 
medicines  and  quack  doctors  have  led  you  to 
believe  that  catarrh  is  some  horrible  and  incurable 
disease.  Catarrhal  deafness  is  a  serious  affec- 
tion, but  often  it  can  be  cured  and  almost  always 
it  can  be  checked  in  its  course  and  prevented  from 
getting  worse. 

Don't  buy  a  set  of  artificial  ear-drums;  they 
will  not  help  you.  Ear  affections  that  can  be 
benefited  by  such  means  are  very  rare. 

Don't  believe  any  newspaper  advertisements 
claiming  to  restore  hearing;  they  are  all  false. 
Your  own  common  sense  ought  to  tell  you  (i) 
that  even  the  most  expert  physician  could  not 
explain  the  nature  of  your  trouble  nor  the  line 
of  treatment  required  without  making  an  ex- 
amination of  you;  (2)  that  advertisements  bear- 
ing the  signature  of  "Doctor  Anybody"  are  fraud- 
ulent, for  only  "quacks"  advertise,  and  all  quacks 
are  liars. 


86  THE  EAR. 

Don't  apply  poultices  to  the  ear  under  any 
circumstances,  and  don't  pour  heated  oils  #or 
ins^--stteh--ah£Hiiinj^ 

taps-  into  the  ear  for  relief  of  pain;  the  only 
benefit  to  be  derived  from  such  remedies  is  due 
to  the  application  of  heat,  and  this  can  be  ob- 
tained in  a  more  cleanly  and  satisfactory  way  by 
use  of  the  hot-water  bag;  furthermore,  oils  and 
fats  congeal  in  the  canal  and  on  the  drum-head 
and  cause  trouble  later. 


Ill, 

NOSE  AND  THROAT. 


THE  two  special  senses  that  are  housed  here 
are  by  no  means  of  such  importance  as  those 
considered  in  the  previous  chapters.  Each  adds 
something^to  the  pleasures,  of  life,  but  neither 
is  indispensable.  The  sense  of  smell^ enables  us 
to  extract  from  nature  an  additional  appreciation 
of  many  of  her  delights ;  how  much  more  enjoy- 
able are  flowers  when,  added  to  their  visual 
beauty,  we  have  the  pleasure  of  their  delightful 
odors !  It  is  almost  purely  an  esthetic  sense,  only 
a  very  few  people  finding  it  of  any  economic  value 
in  their  lives.  To  a  less  degree,  the  same  thing 
may  be  said  of  the  sense_of  taste,  _a^j^nse__that 
adds_very_greatly  to  our  pleasures,  but  which  is 
not  at  all  necessary  to  life  or  happiness,  nor  of 
material  value  in  the  pursuance  of  ordinary  oc- 
cupations. There  are_a. .few  persons  in  the  world 
who  make  a  living  from  the  use  of  these  senses; 
judging  perfumes,  testing  the  values  of  teas  by 
their  taste,  etc.,  but  their  proportion  in  the  whole 
laboring  population  is  an  insignificant  percentage. 
Total  loss  of  ability  to  smell  or  to  taste  things, 

(87)  ' 


88  NOSE  AND  THROAT. 

especially  the  latter,  would  deprive  one  of  much 
of  the  pleasure  ordinarily  derived  from  eating, 
would  convert  what  is  generally  a  delightful 
pastime  into  a  mere  compulsory  process  and  per- 
functory function  for  the  sustentation  of  life; 
all  food  tasting  alike,  the  eater  would  not  care 
much  what  was  served  to  him  and  would  eat 
solely  for  the  purpose  of  maintaining  existence. 

Partial  loss  of  these  senses  would,  in  the 
same  way,  be  considered  a  deprivation  in  that  it 
interferes  with  tha^  full  enjoyment  of  many 
things  that  tend  to  make  us  happy  and  contented, 
but  could  not  be  callecKa  serious  calamity.  So 
there  is  a  marked  distinction  between  the  two 
very  important  senses  considered  heretofore, 
sight  and  hearing, — senses  so  important  to  the 
personal  economy  as  well  as  to  the  pleasure- 
producing  elements, — and  the  two  lesser  special 
senses  that  have  their  terminal  apparatus  in  the 
nose  and  mouth. 

Unlike  the  eye  and  ear,  which  are  organs 
designed  solely  for  the  production  and  develop- 
ment of  function  of  the  special  senses  of  sight 
and  hearing,  the  nose  and  throat  are  only  in- 
cidentally concerned  in  the  elaboration  of  smell 
and  taste.  \The  nose,  and  throat,  ajre  of  much 
greater  importance  in  the  human  economy  be- 
cause of  their  relationship  with  the  organs  of 


NASAL  STRUCTURE.  89 

respiration  and  of  nutrition,  the.  channels  for 
admission  of  air  to  the  lungs  and  of  food  to  the 
stomach.  Consequently  in  considering  their  care 
we  shall  have  to  treat  them  more  particularly 
with  reference  to  these  functions  and  have  but 
little  to  say  about  the  special  senses,  f 

Anything  like  a  complete  description  of  the 
anatomical  structure  of  the  nose  and  throat 
would  be  an  inexcusable  waste  of  space  in  such 
a  short  chapter  as  this  must  be,  because  so  much 
of  it  is  of  so  little  importance  to  the  layman.  It 
would  be  more  to  the  point  to  take  up  for  detailed 
consideration  some  parts  that  ought  to  be  better 
understood  by  all  intelligent  persons,  and  to  ex- 
plain their  position,  formation,  and  abnormal 
development. 

NASAL  STRUCTURE. 

The  nose  is  divided  into  two  equal  portions, 
right  and  left  nasal  chambers,  by  a  cartilaginous 
septum,  and  this  median  wall  is  covered  on  both 
sides  by  smooth  mucous  membrane.  The  lateral 
or  outer  walls  of  both  sides  are  of  irregular  con- 
tour, being  constructed  of  three  scroll-shaped 
bones  placed  one  above  the  other,  the  lower  one 
being  the  largest.  These  bones  are  rather  thin, 
and  by  an  arrangement  which  permits  their 


90  NOSE  AND  THROAT. 

overlapping  and  extending  out  into  the  nasal 
chamber,  as  well  as  forming  the  lateral  wall,  their 
mucous-membrane-covered  surface  is  more  than 
double  what  would  have  existed  in  a  plane-sur- 
faced wall.  The  reason  for  providing  this  ex- 
tensive area  of  vascular  tissue  is  found  in  the 
fact  that  one  of  the  functions  of  the  nose  is  the 
warming  and  moistening  of  inspired  air  prepara- 
tory to  its  admission  to  the  lungs;  the  mucous 
membrane  covering  the  bones  and  the  septum  is 
very  vascular,  carries  a  large  blood-supply,  and 
the  air  in  passing  over  this  heated  membrane  has 
its  chill  removed  and  is  thus  rendered  less  irri- 
table than  cold  air  would  be  to  the  sensitive  lung  / 
tissue.  The  roof  of  the  nasal  chambers  is  parv 
of  the  bony  floor  of  the  skull,  directly  over  which  / 
lies  brain  substance.  Posteriorly  the  nasar 
chambers  open  into  the  upper  and  back  part  of 
the  throat  by  orifices  that  correspond  in  a  measure 
to  the  external  orifices  opening  on  the  face.  Be- 
tween the  turbinate  bones  (those  referred  to 
above  as  scroll-shaped)  there  are  several  small 
openings  of  canals  or  cells  that  connect  the  nose 
with  neighboring  structures.  For  instance,  the 
tear-ducts,  which  convey  tears  from  the  inner 
margins  of  the  lids,  open  into  the  nose  under  the 
inferior  turbinates ;  the  big  cavities  in  the  cheek- 
bones (antrum  of  Highmore)  and  behind  the 


Fig.  3. — Showing  lateral  aspects  of  nasal  cham- 
bers and  neighboring  structures.  The  turbinate  bones 
are  especially  well  depicted. 


NASAL  STRUCTURE.  91 

eyebrows  (frontal  sinuses),  as  well  as  the  so- 
called  bone  sinuses  in  the  center  of  the  head 
(ethmoid  and  sphenoid  sinuses),  communicate 
with  the  nose  in  a  similar  way,  and  empty  their 
secretions  into  the  nasal  chambers. 

From  this  it  will  be  seen  that  the  physiological 
function  of  the  nose  is  threefold.  Primarily,  it  is 
the  organ  through  which  we  appreciate  odors. 
In  the  second  place,  it  is  of  importance  in  the 
act  of  breathing,  not  only  constituting  a  channel 
for  the  ingress  of  air,  but  preparing  that  air  for 
admission  to  the  lungs.  Thirdly,  it  is  a  drainage 
canal  for  the  removal  of  the  mucus  and  watery 
secretions  of  the  neighboring  cavities  and  struc- 
tures of  the  head.  Abnormalities  in  formation, 
deformities  resulting  from  injury,  or  changes 
resulting  from  disease  may  interfere  with  any 
or  all  of  these  functions.  If  the  turbinate  bones 
are  abnormally  large  or  if  the  septum  be  deflected 
to  one  side,  there  will  be  an  obstruction  of  respi- 
ration and  impaired  breathing  through  that  side 
of  the  nose.  Such  deformities  may  be  congenital, 
that  is,  present  from  the  time  of  birth,  or  may 
result  from  injury — a  broken  nose  often  heals 
with  deformity  of  the  septum — or  there  may  be 
a  slowly  progressive  growth  of  the  turbinates 
until  they  reach  obstructive  size.  Inflammations 
of  the  mucous  membrane  alone  may  be  accom- 


92  NOSE  AND  THROAT. 

panied  by  so  much  swelling  that  the  nasal 
chambers  are  occluded  and  breathing  through  the 
nose  becomes  difficult  or  even  impossible. 


RHINITIS  (COLD  IN  THE  HEAD). 

The  so-called  "cold  in  the  head"  is  an  acute 
inflammation  of  the  membrane  lining  the  nose 
and  is  caused  by  micro-organisms.  The  influence 
of  cold  alone  does  not  produce  the  condition 
usually  referred  to  when  we  speak  of  a  cold  in 
the  head;  the  condition  is  generally  an  infection, 
the  result  of  germs  gaining  entrance  to  the 
tissues.  The  part  played  by  cold  is  merely  a 
predisposing  one.  Prolonged  exposure  to  cold 
reduces  the  resisting  power  of  the  mucous  mem- 
brane because  the  effect  of  cold  upon  any  vascular 
tissue  is  to  diminish  its  blood-supply  by  causing 
a  contraction  of  the  smaller  blood-vessels.  When 
the  nasal  tissue  has  become  weakened  and  less 
resistant  in  this  way,  germs,  which  are  always 
lurking  about  the  nose  and  mouth,  take  advan- 
tage of  their  opportunity  for  an  attack  and  pro- 
duce an  inflammation.  As  elsewhere,  the  first 
effect  of  inflammation  is  swelling  and  exudation, 
which  accounts  for  the  stuffy  sensation  of  a 
"cold"  in  the  nose  and  the  very  free  flow  of 
secretion  that  soon  follows.  Pain  and  fever  are 


RHINITIS.  93 

the  other  symptoms  of  inflammation,  and  we 
have  them  in  a  "cold"  in  proportion  to  the  amount 
of  area  involved  and  the  virulence  of  the  infec- 
tion. Thus,  if  the  inflammation  spreads  over  the 
nasal  chamber  and  into  the  sinuses  or  channels 
described,  the  absorbing  surface  is  larger  and  the 
systemic  effects  greater  than  if  the  disease  be 
limited  to  the  walls  of  the  nose  proper.  The  pain 
is  greatly  increased  if  some  of  the  purulent  secre- 
tions get  penned  up  in  the  sinuses  and  the  swollen 
tissues  prevent  their  escape;  thus  causing  a 
condition  of  abscess,  as  it  were.  So  you  see  a 
cold  in  the  head  is  not  always  a  simple  thing;  it 
may  cause  great  distress  from  the  local  effect 
only,  or  it  may  spread  to  other  regions  and  even 
invade  the  brain  with  fatal  effect.  The  type  of 
micro-organism  has  much  to  do  with  the  char- 
acter of  inflammations  that  we  are  accustomed 
to  group  under  the  general  head  of  "colds."  The 
germs  most  commonly  concerned  are  the  simpler 
pus-producing  ones,  but  sometimes  there  are  espe- 
cially virulent  organisms  to  be  considered,  as  in 
the  epidemic  influenzas,  the  grippes,  where  a 
large  percentage  of  the  population  may  be  affected 
by  a  specific  germ  introduced  into  the  community 
and  favored  in  its  dastardly  work  by  an  accom- 
panying cold  wave.  While  these  "colds"  differ 
in  minor  details  they  are  in  general  much  alike, 


94  NOSE  AND  THROAT. 

and  even  the  most  simple  of  them,  under  ordinary 
circumstances,  may  in  some  instances  prove  to  be 
very  dangerous. 

A  cold  in  the  head  should  never  be  neglected. 
First,  because  it  is  not  of  itself  a  dangerless 
thing.  Secondly,  because  it  may  readily  become 
a  chronic  inflammation  or  may  cause  lesions  or 
modifications  in  structure  of  the  nose  that  leave 
it  an  injured  organ. 


CHRONIC  RHINITIS  (NASAL  CATARRH). 

A  chronic  cold  in  the  head,  one  that  has 
existed  for  some  months  or  even  years,  is  com- 
monly spoken  of  as  "catarrh,"  and  right  here  let 
me  say  that  this  is  a  very  much  abused  word. 
The  outrageously  deceptive  advertisements  of 
"catarrh  cures,"  promulgated  by  the  patent 
medicine  manufacturers  or  the  quack  doctors 
who  prey  upon  the  all  too  credulous  public  with 
humbuggery  in  various  forms,  have  so  played 
upon  this  word  that  perhaps  the  majority  of 
people  believe  "catarrh"  to  be  a  horribly  dis- 
gusting, terribly  dangerous,  and  almost  incurable 
disease.  Now,  as  a  matter  of  fact,  it  is  seldom 
any  of  these  things.  They  have  used  the  super- 
lative adjectives  when  those  of  less  degree 
would  better  explain  the  true  condition.  It  is 


CHRONIC  RHINITIS.  95 

true  that  the  affection  is  always  unpleasant, 
sometimes  quite  objectionable;  rarely  disgusting 
either  to  the  victim  or  his  friends.  It  is  true 
that  it  sometimes  spreads  to  neighboring  struc- 
tures and  causes  complications  of  a  serious 
nature,  but  only  in  a  very  small  percentage  of 
cases  does  it  actually  endanger  life.  It  is  true 
that  it  is  inclined  to  be  chronic  and  persistent 
unless  properly  treated,  but  it  is  not  at  all  to  be 
classed  as  an  incurable  affection,  the  percentage 
of  cases  that  resist  treatment  by  a  competent 
physician  being  very  small.  If  colds  in  the 
head  were  properly  regarded  and  wisely  cared 
for  in  the  beginning,  there  would  be  very  few 
cases  of  the  chronic,  or  so-called  "catarrhal," 
type  resulting.  Catarrh  comes,  in  the  main,  from 
the  neglect  of  simple  colds  or  from  failure  to 
safeguard  one's  self  against  repeated  attacks,  and 
may,  therefore,  be  said  to  be  to  a  large  extent 
a  preventable  disease.  But  supposing'  that  inclem- 
ent weather  or  unavoidable  exposure  or  inability 
to  take  care  of  one's  health  results  in  a  condition 
of  chronic  nasal  inflammation,  it  is  still  a  disease 
amenable  to  treatment,  and  if  treated  in  the 
proper  wray  it  will  almost  invariably  respond 
promptly  with  a  cure.  The  use  of  a  "snuff,"  the 
swallowing  of  pills  or  potions,  the  carrying  of  an 
electric  battery  in  the  pocket,  or  the  wearing  of 


96  NOSE  AND  THROAT. 

some  fol-de-rol  in  the  shoes  is  not,  however, 
proper  treatment;  that  is  the  sort  of  treatment 
occasionally  advised  by  quacks  or  set  forth  in  the 
advertisements  of  patented  articles,  and  designed 
rather  to  catch  the  dollars  of  the  foolish  than  to 
cure  the  disease. 

Let  us  consider  what  "catarrh"  really  is,  that 
we  may  understand  its  most  disagreeable  and 
dangerous  features,  recognize  the  necessity  for 
getting  rid  of  it,  and  appreciate  the  nature  of  the 
treatment  required  to  bring  about  its  cure. 

In  the  first  place  the  word  "catarrh"  is  defined 
in  the  medical  dictionary  as  "inflammation  of  a 
mucous  membrane,  with  a  free  discharge."  Now, 
that  does  not  sound  very  terrifying.  Any  inflam- 
mation of  any  mucous  membrane  of  the  body 
must  be  accompanied  by  a  discharge;  conse- 
quently they  are  all  "catarrhal"  inflammations, 
strictly  speaking.  Pink-eye  is  a  catarrhal  inflam- 
mation of  the  eyes;  a  running  ear  is  a  catarrhal 
inflammation  of  the  ear;  appendicitis  is  a  catar- 
rhal inflammation  within  the  appendix;  a  simple 
cold  in  the  head  is,  from  a  scientific  point  of  view, 
just  as  much  a  catarrh  as  is  the  chronic  type  of 
nasal  inflammation.  Why  then  has  the  word 
come  into  such  disrepute?  All  inflammations 
must  have  a  beginning,  an  acute  stage.  If  the 
inflammation  naturally  subsides  quickly,  or  is 


CHRONIC  RHINITIS.  97 

either  cured  or  proves  fatal  within  a  short  time, 
no  serious  consideration  is  given  by  the  public  to 
the  name  applied  to  it.  If  the  inflammation,  from 
any  cause,  tarries  long  and  passes  into  the 
chronic,  meaning  long-continued,  stage  it  be- 
comes not  only  more  of  a  nuisance,  but,  usually, 
more  dangerous  to  one's  welfare,  and  its  name 
attracts  more  attention.  Quite  naturally,  then, 
the  term  "catarrh"  has  attached  itself  rather  to 
the  long-continued  inflammations  that  are  marked 
by  a  discharge;  and  since  chronic  inflammations 
of  the  air  passages  are  by  all  odds  the  most  com- 
monly observed  of  this  type  of  affection,  the  word 
has  grown  to  be  rather  limited  in  its  use  by  the 
public  to  persistent  inflammations  of  the  nose  and 
throat.  Unfortunately  a  considerable  number  of 
physicians,  feeling  the  backward  pressure  of  the 
public  mind  in  this  matter,  have  carelessly  fallen 
into  the  habit  of  using  the  word  in  the  same  way, 
though  it  is  to  be  hoped  still  with  a  better  under- 
standing of  the  actual  conditions.  As  there  are 
in  almost  every  community  that  is  at  all  thickly 
settled  some  persons  who  from  ignorance  or 
neglect  have  allowed  a  nasal  or  throat  inflam- 
mation to  pass  into  a  stage  of  seriousness,  and 
as  the  charlatans  have  by  a  continuous  perform- 
ance kept  before  the  public  artfully  contrived 
pictures  of  these  poor  victims,  as  horrible 


98  NOSE  AND  THROAT. 

examples  of  what  any  nasal  inflammation  might 
become,  a  great  many  laymen  have  finally  ac- 
cepted the  word  "catarrh"  as  describing  a  very 
serious  group  of  purulent  infections  of  the  nose, 
throat,  or  lungs.  The  condition  is  utterly  un- 
justifiable and  unreasonable,  but  there  is  little 
wonder  that  the  word  has  come  to  mean  some- 
thing dreadful  to  the  average  person,  or  that 
many  patients  say,  with  a  worried  expression  on 
their  faces,  "Don't  tell  me  I  have  catarrh."  Well, 
if  you  have  a  persistent  discharge  from  your  nose 
or  a  more  or  less  constant  hawking  and  spitting 
of  something  from  the  throat,  you  have  catarrh; 
but  having  said  that,  we  have  not  pronounced 
your  doom  nor  put  upon  you  the  stigma  Biblically 
applied  to  the  leper — unclean. 

Having  defined  the  word,  let  us  now  study 
more  particularly  the  conditions  to  which  it  is 
applied;  and  since  the  profession  as  well  as  the 
public  generally  mean  a  chronic  inflammation  of 
the  nose  when  the  term  catarrh  is  used,  we  shall 
limit  the  description  to  that  region.  It  has  been 
explained  that  an  acute  inflammation  of  the  nose, 
a  cold  in  the  head,  arises  from  the  action  of 
micro-organisms  upon  the  nasal  mucous  mem- 
brane that  has  been  weakened  by  exposure  to  the 
influences  of  cold.  Exposure  to  cold  may,  of 
course,  be  of  various  kinds;  having  to  remain 


CHRONIC  RHINITIS.  99 

out  for  a  long  time  in  a  cold  wind,  in  a  rain  or 
snow  storm;  being  transported  suddenly  from  a 
warm  into  a  much  colder  atmosphere;  sitting  in 
a  cold  place  with  improper  or  insufficient  clothing 
to  protect  one  against  chilling  of  the  body;  get- 
ting the  feet  wet  and  not  being  able  soon  to 
secure  dry  footwear,  and  so  a  hundred  different 
means  might  be  mentioned.  As  a  general  rule, 
an  acute  cold  in  the  head  is  for  the  normal  healthy 
individual  a  self-limited  disease  lasting  on  the 
average  about  nine  days.  Why  should  some 
cases  become  chronic  ?  There  are  many  reasons ; 
the  person  may  not  have  a  normal,  healthy  re- 
sistance, and  his  weaker  tissues  fall  an  easy  prey 
to  the  germs ;  the  germs  may  be  of  an  especially 
virulent  nature  and  produce  a  more  serious  or 
more  chronic  form  of  inflammation  than  usual; 
instead  of  taking  care  of  himself  and  trying  to 
get  rid  of  the  cold,  the  patient  may  be  subjected 
to  continuous  or  repeated  exposures;  finally, 
neglect  or  inappropriate  treatment  may  result  in 
prolonging  an  acute  infection  into  a  chronic  one. 
The  longer  the  inflammation  exists,  the  more 
it  tends  to  spread  beyond  the  original  site  of  in- 
fection, and  the  greater  will  be  the  destruction  of 
tissue.  Very  few  chronic  cases,  then,  are  limited 
to  inflammation  of  the  mucous  membrane  of  the 
lateral  walls  or  the  septum  of  the  nose.  Instead, 


100  NOSE  AND  THROAT. 

the  disease  has  caused  an  ulceration  of  the  deeper 
tissues  or  has  invaded  the  neighboring  sinus 
spaces  of  which  we  have  spoken.  Secretions 
formed  in  these  sinuses  and  large  cells  drain  into 
the  nose  only  imperfectly,  and  the  portion  that 
fails  to  flow  out,  the  residuum  retained  in  these 
spaces,  tends  to  keep  up  a  constant  reproduction 
of  more  inflammation  and  more  pus.  In  the 
majority  of  cases  of  chronic  nasal  catarrh  an 
examination  discloses  the  presence  of  diseased 
bone  or  of  abscess  cavities  in  these  cellular  spaces. 
In  this  connection  it  may  be  noted  that  this  ex- 
plains why  proper  treatment  resolves  itself  into 
providing  drainage  from  these  spaces,  so  as  to 
permit  complete  removal  of  the  products  of 
inflammation  and  the  taking  away  of  as  much 
dead  or  diseased  bone  as  interferes  with  proper 
drainage  and  ventilation  of  the  nasal  cavities  or 
the  presence  of  which  serves  to  promote  further 
inflammatory  action. 

The  symptoms  of  chronic  nasal  catarrh  are 
not  difficult  of  recognition,  and  little  need  be  said 
about  how  to  determine  the  existence  of  the  dis- 
ease; the  exact  points  of  diagnosis  do  not  come 
within  the  scope  of  the  layman,  it  being  suffi- 
cient that  he  should  recognize  the  fact  that  certain 
symptoms  indicate  chronic  nasal  disease  and  call 
for  the  attention  of  a  skilled  physician,  whose 


CHRONIC  RHINITIS.  1Q1 

duty  it  is  to  ascertain  the  location  and  extent  of 
the  trouble  and  to  prescribe  the  proper  treatment. 
When  evidences  of  a  cold  in  the  head  are  con- 
stantly present  or  recur  frequently  upon  slight 
provocation,  it  may  be  taken  for  granted  that 
there  is  something  abnormal  within  the  nose. 
Inability  to  breathe  freely  through  either  side  of 
the  nose  is  proof  of  some  unnatural  obstruction, 
inside  the  nose  or  behind  it,  where  it  should  open 
into  the  upper  portion  of  the  throat,  and  if  this 
condition  be  accompanied  by  mucous  or  purulent 
secretions  from  the  nose  the  obstruction  is  most 
probably  caused  by  inflammatory  swelling  result- 
ing from  a  catarrhal  process.  When  there  is 
regularly  present  a  thick,  clear  mucous  discharge 
or  a  yellowish  purulent  discharge  from  the  nose, 
requiring  frequent  employment  of  a  handker- 
chief, there  is  almost  surely  a  chronic  catarrhal 
inflammation  that  has  extended  to  the  cellular 
spaces.  If  the  sense  of  smell  is  impaired,  or  if 
the  breath  of  a  person  having  such  a  nasal  secre- 
tion is  foul  of  odor,  the  chances  are  that  an  ex- 
tensive, destructive  nasal  inflammation  is  the 
cause.  Headache  is  a  not  uncommon  sign  of 
nasal  disease,  especially  when  the  pain  is  most 
pronounced  over  the  eyebrows  or  deep  in  the 
bone  below  the  eyes. 

It  is  not  intended  to  discuss  here  the  methods 


102  NOSE  AND  THROAT. 

and  forms  of  treatment  that  may  be  employed 
for  the  cure  of  disease;  it  is  the  function  of  this 
book  only  to  make  it  possible  for  the  non-medical 
reader  to  recognize  the  existence  of  an  abnormal- 
ity or  of  diseased  conditions,  and  to  distinguish 
in  a  measure  between  the  simple  and  the  danger- 
ous affections.  Self-medication  is  a  curse  to  any 
people.  The  accurate  diagnosis  and  scientific 
treatment  of  disease  is  an  art  that  requires  years 
of  painstaking  study  to  even  fairly  comprehend; 
leave  the  practice  of  medicine  to  those  who  have 
endeavored  to  fit  themselves  for  its  onerous  and 
responsible  duties.  Not  even  everyone  who 
holds  the  title  of  doctor  is  competent  to  treat  all 
diseases.  All  legitimate  practitioners  of  medicine 
are  expected  to  know  something  of  all  diseases, 
but  the  entire  field  of  medicine  is  so  large  that  it 
is  impossible  for  any  but  the  most  exceptional 
men  to  know  all  about  it;  hence  the  growth  and 
development  of  specialism,  men  devoting  their 
time  to  the  study  of  the  diseases  of  one  or  two 
organs.  It  is  reasonable  to  expect  that  specialists 
in  diseases  of  the  nose  and  throat  should  be  more 
capable  of  understanding  and  more  skillful  in  the 
treatment  of  affections  of  these  organs  than  the 
family  physician,  whose  duties  require  attention 
to  many  subjects;  and  so  it  is  wiser  to  consult 
such  a  one  when  disease  of  this  region  is  sus- 


CHRONIC  RHINITIS.  1Q3 

pected.  Further,  the  mere  proclamation  that  one 
is  a  specialist  does  not  necessarily  mean  that  he 
is  the  most  learned  or  skillful  of  his  class ;  he  may 
really  be  little  better  than  the  general  family 
physician  who  makes  no  pretense  of  special 
knowledge  or  training.  Unfortunately,  the  laws 
at  present  permit  almost  anyone  possessed  of  the 
degree  of  Doctor  of  Medicine,  and  many  who 
have  not  that  much  tangible  evidence  of  medical 
knowledge,  to  declare  themselves  to  the  public  as 
specialists  in  some  branch  of  medicine.  In  no 
other  department  of  medicine  has  this  fact  been 
more  abused  than  in  the  consideration  of  diseases 
of  the  nose  and  throat,  and  there  are  far  too 
many  incompetents  prescribing  for  and  even 
operating  within  this  area.  There  is  no  infallible 
rule  for  selecting  a  competent  physician  or  sur- 
geon. The  man  with  the  greatest  reputation  is 
not  always  or  necessarily  the  most  capable  and 
skillful  in  his  vicinity;  an  intelligent  young  man 
may  excel  in  capability  and  skill  his  gray-haired 
neighbor  who  is  better  known  in  social  and  pro- 
fessional circles;  it  can  only  be  said  that  when 
the  services  of  a  specialist  are  needed  one  should 
carefully  consider  to  whom  he  will  entrust  his 
case  and,  before  deciding,  make  honest  endeavor 
to  secure  the  best  available  assistance.  If  such 
a  rule  had  been  more  generally  followed  in  the 


104  NOSE  AND  THROAT. 

past,  instead  of  the  haphazard  method  of  permit- 
ting anybody  to  tamper  with  the  nose,  or  of  let- 
ting its  diseases  entirely  alone,  "catarrh"  would 
never  have  come  to  be  looked  upon  with  such 
terror.  It  has  been  shown  to  be  a  condition  that 
is  susceptible  of  cure  if  properly  treated,  but  it 
must  be  stated  that  its  proper  treatment  requires 
the  aid  of  a  competent,  specially  trained  physician. 

AFFECTIONS  OF  THE  TONSILS. 

On  either  side  of  the  throat,  hear  the  base  of 
the  tongue  and  just  below  the  soft  palate,  may 
often  be  seen  a  small,  soft,  glandular  structure 
called  a  tonsil.  In  the  normal  adult  human  being 
it  is  scarcely  visible,  but  in  children  it  can  fre- 
quently be  seen  as  an  almond-shaped  body  pro- 
jecting slightly  from  the  lateral  wall  of  the 
pharynx.  If  the  tonsil  has  any  useful  function 
in  nature  that  fact  has  never  been  discovered,  and 
at  the  present  time  the  best  medical  opinion  seems" 
to  be  that  it  is  a  useless,  functionless  appendage 
much  more  likely  to  be  a  nuisance  than  a  benefit 
to  its  possessor.  It  is  most  desirable  to  be  born 
without  tonsils,  at  least  without  visible  evidences 
thereof ;  but  being  so  unfortunate  as  to  have  them 
present  at  birth,-  one  can  only  hope  that  they  will 
disappear  early  by  a  process  of  atrophy.  Very 


AFFECTIONS  OF  THE  TONSILS.  1Q5 

many  children  miss  this  blessed  occurrence,  how- 
ever, and  in  them  the  tonsil  shows  a  tendency  to 
increase  in  its  size,  to  grow  and  to  become  what 
is  technically  called  "hypertrophied,"  when  they 
may  interfere  seriously  with  the  child's  health; 
first,  through  interference  with  the  acts  of  breath- 
ing and  swallowing;  secondly,  through  the  ease 
with  which  they  become  infected  and  inflamed 
(tonsillitis)  ;  thirdly,  by  their  deleterious  influence 
upon  the  child's  speech  and  hearing. 

One  can  readily  understand  how  the  enlarged 
tonsils,  projecting  into  the  throat  until  they 
almost  or  quite  meet  each  other,  obstruct  the 
natural  act  of  swallowing  and  prevent  the  free 
ingress  of  air;  nature  probably  did  not  intend 
that  we  should  rely  to  any  great  extent  upon 
the  mouth  for  breathing  purposes,  but,  since  en- 
larged tonsils  so  frequently  occur  coincidently 
with  nasal  obstructions,  they  interfere  at  times 
with  this  reserve  method  of  respiration.  These 
very  large  tonsils,  however,  do  much  more  than 
merely  obstruct  the  passage  of  air  and  food;  by 
their  pressure  upon  neighboring  soft  tissues  they 
interfere  with  the  muscular  action  of  the  soft 
palate  necessary  to  distinct  enunciation  in  speech, 
and  close  the  orifices  of  the  tubes  which  lead  from 
the  throat  to  the  ear  (the  Eustachian  tube,  that 
opens  just  above  and  behind  the  soft  palate  and 


106  NOSE  AND  THROAT. 

the  posterior  openings  of  the  nose)  for  the  ad- 
mission of  air  to  the  ear-drums.  As  has  been 
explained  elsewhere,  closure  of  these  tubes  causes 
a  rarefaction  of  the  air  in  the  drum-cavities,  a 
sinking  in  of  the  drum-head  and  either  a  mild 
catarrhal  inflammation  in  the  ears  or  a  diminu- 
tion of  hearing  power,  or  both.  Furthermore, 
such  tonsils  are  especially  prone  to  infection  and 
to  suffer  from  the  effects  of  cold,  so  that  children 
having  enlarged  tonsils  are  subjected  to  frequent 
attacks  of  sore  throat  (tonsillitis),  and  often  these 
attacks  are  accompanied  or  followed  by  com- 
plaints of  earache,  occasionally  even  by  abscesses 
in  the  drums. 

The  influence  of  the  tonsils  on  the  voice  is  a 
matter  worthy  of  much  more  consideration  than 
it  has  generally  received.  Children  with  tonsils 
almost  invariably  have  a  thick  voice  or  a  nasal 
twang,  and  speak  indistinctly.  A  full,  rich, 
mellow  voice  is  next  to  impossible  for  a  person 
whose  throat  space  is  restricted  by  abnormal 
growths,  like  hypertrophied  tonsils  or  adenoids. 
It  is  important  that  this  should  be  clearly  under- 
stood because  patients  often  explain  their  hesi- 
tancy to  submit  to  operation  by  saying  that  they 
fear  removal  of  the  tonsils  will  affect  the  voice; 
it  will  affect  the  voice,  but  the  effect  will  be  in 
the  nature  of  an  improvement.  .  By  removing 


AFFECTIONS  OF  THE  TONSILS.  107 

the  abnormal  growth  that  encroaches  upon  the 
resonance  space,  for  the  throat  is  a  resonance 
chamber  for  the  musical  voice;  by  reducing  the 
state  of  chronic  inflammation  of  the  throat  that 
generally  accompanies  diseased  tonsils,  and  thus 
getting  rid  of  irritating  secretions,  the  voice  is 
generally  much  improved  in  quality  and  can  be 
used  more  easily  and  for  longer  periods  of  time 
without  fatigue.  Thus  singers,  lawyers,  minis- 
ters, and  other  public  speakers  who  have  been 
seriously  handicapped  by  failure  to  produce  cer- 
tain notes  clearly  or  inability  to  speak  distinctly, 
or  without  effort  for  more  than  a  few  minutes, 
find  themselves  able  to  sing  purely,  or  to  speak 
distinctly  and  for  a  prolonged  period,  after 
having  had  their  affected  tonsils  removed. 

When  the  tonsils  persist  on  into  adult  life 
they  are  not  only  subject  to  the  above-named 
conditions,  but  have  a  further  series  of  disorders 
peculiarly  their  own.  The  very  large,  hyper- 
trophied  tonsil  is  rarely  seen  in  persons  beyond 
the  age  of  puberty.  Any  visible  tonsil  after  this 
time  of  life  is  probably  abnormal  and  should  be 
carefully  examined  to  ascertain  whether  it  is 
diseased  and  a  possible  source  of  trouble  com- 
plained of,  perhaps,  at  a  remote  point.  It  has 
come  to  be  a  recognized  fact  now  that  not  only 
are  many  cases  of  deafness  and  other  aural 


108  NOSE  AND  THROAT. 

affections  directly  traceable  to  diseased  tonsils, 
even  though  small  in  size,  but  that  such  systemic 
affections  as  rheumatism  may  be  attributable  to 
toxins  absorbed  through  or  manufactured  within 
the  tonsil.  Peculiarly  enough,  it  is  not  the  grossly 
enlarged  tonsils  that  are  the  worst  offenders  in 
this  respect,  but  the  small,  so-called  "submerged" 
tonsils  (tonsils  that  may  be  of  considerable  size, 
but  are  not  visible  as  projecting  large  tonsils 
because  they  have  been  overgrown  by  and  lie 
buried  under  the  loose  tissues  of  the  palate),  with 
cheesy-looking,  yellowish  particles  collected  in 
their  crypts  that  cause  the  systemic  infections. 

Every  child  that  is  a  mouth-breather  or  that 
has  frequent  attacks  of  sore  throat  or  earache, 
and  every  older  person  who  shows  signs  of  begin- 
ning or  advancing  deafness,  or  who  has  repeated 
sore  throats  or  suffers  from  joint  troubles  and 
other  complaints  of  a  rheumatic  character,  should 
have  a  careful  investigation  made  of  the  nose 
and  throat,  particularly  with  reference  to  the 
tonsils.  The  enlarged  tonsil  of  early  childhood 
is  not  difficult  of  recognition,  even  by  the  parents, 
but  it  requires  more  skill  to  determine  the  exist- 
ence and  condition  of  the  smaller  diseased  tonsils 
of  adults.  Many  cases  of  ear  disease  are  cured, 
many  more  are  checked  in  their  downward 
career  by  prompt  and  proper  attention  to  the 


Fig.  4. — View  of  throat  in  which  can  be  seen 
small  diseased  tonsils  and  parts  of  an  adenoid  hanging 
below  the  soft  palate  on  either  side  of  the  mouth. 


AFFECTIONS  OF  THE  TONSILS.  109 

tonsils  and  to  coincident  nasal  or  throat  condi- 
tions. Many  cases  of  rheumatism,  affecting  in 
some  instances  the  large  joints  of  the  body,  have 
been  relieved  and  recurrence  entirely  prevented 
by  the  removal  of  small,  but  diseased  tonsils  the 
existence  of  which  had  perhaps  not  been  sus- 
pected by  the  patient.  In  addition,  it  may  also 
be  said  that  many  cases  of  such  affections  of  the 
ears  and  of  the  joints  cannot  be  cured  nor 
materially  benefited  by  any  other  treatment  until 
the  diseased  tonsils  have  been  removed. 

While,  as  has  been  stated  before,  it  is  not  de- 
sirable to  enter  upon  a  discussion  of  the  treat- 
ment of  disease  here,  it  seems  necessary  in  this 
matter  to  give  some  advice  on  the  subject.  This 
is  necessitated  by  the  fact  that  the  only  treatment 
worthy  of  consideration  is  of  a  surgical  nature, 
and  by  the  further  fact  that  many  people  are 
averse  to  acknowledging  the  plain,  palpable  truth 
of  the  situation.  It  is  perfectly  natural  to  desire 
to  avoid  any  sort  of  an  operation;  no  one  is 
anxious  to  be  operated  upon  for  any  ailment 
whatsoever.  It  is  not,  therefore,  surprising  that 
some  persons  should  beg  that  their  tonsils  be 
"treated,"  that  applications  be  tried  or  medicines 
administered  in  the  hope  of  "shrinking"  the 
tonsils  or  driving  them  away.  Parents  not  in- 
frequently inquire  whether,  if  the  child  be  let 


HO  NOSE  AND  THROAT. 

alone,  the  tonsil  will  not  atrophy  and  disappear 
at  about  the  age  of  puberty.  There  is  no  satis- 
factory proof  and  no  reasonable  assurance  that 
such  a  thing  can  or  will  take  place,  and  while 
waiting  for  such  an  unlikely  event  to  transpire 
the  child  is  subjected  to  all  the  dangers  and  dis- 
comforts that  attend  retention  of  the  tonsils;  the 
dangers  are  not  inconsiderable  in  this  connection, 
because  such  diseases  as  scarlet  fever,  whooping- 
cough,  and  diphtheria  are  much  more  serious 
when  occurring  in  children  with  enlarged  tonsils 
than  in  those  with  free  throats.  Medicines  may 
be,  and  should  be,  employed  to  reduce  an  acute 
inflammation  of  the  tonsil  before  attempting  an 
operation,  unless  an  emergency  demands  a  dif- 
ferent course;  to  operate  during  the  stage  of 
acute  inflammation  increases  the  risk  of  infection 
of  the  wound  and  prolongs  the  period  of  healing 
after  operation.  It  must  be  acknowledged,  how- 
ever, that  there  is  no  known  medicinal  remedy 
that  will  by  application  or  injection  dispose  of  a 
diseased  or  an  enlarged  tonsil.  To  spray  and 
gargle  and  paint  the  tonsil,  or  to  swallow  pills 
and  potions,  for  any  other  purpose  than  the  allay- 
ing of  acute  symptoms  of  inflammation,  is  a  waste 
of  time  and  a  delusion,  if  the  object  is  to  get  rid 
of  the  diseased  tonsil. 

In  this  connection,  and  for  the  purpose  of 


AFFECTIONS  OF  THE  TONSILS.  HI 

public  education,  it  may  be  well  at  the  same  time 
to  advise  that,  having  decided  upon  an  operation 
upon  the  tonsil,  complete  removal  is  the  thing  to 
be  recommended.  The  oldtime  operations  of 
clipping  the  tonsils,  cutting  bits  off  by  an  instru- 
ment acting  like  a  guillotine,  or  of  cauterizing 
them  with  electrically  heated  wires  are  obsolete 
and  are  performed  only  in  exceptional  cases  at 
the  present  time  by  the  best  authorities.  The 
modern  operation  of  complete  removal  of  the 
tonsil  is  a  major  operation,  comparable  to  re- 
moval of  the  appendix,  and  requires  quite  as 
much,  often  more,  surgical  skill  than  the  last- 
named  operation.  It  should  be  performed  only 
by  thoroughly  trained  men,  and  patients  should 
fully  appreciate  the  fact  that  they  are  to  undergo 
not  a  simple  but  a  serious  operation.  Consider- 
able trouble  has  arisen  from  the  failure  of  the 
public,  and  not  infrequently  of  the  general  mem- 
bers of  the  profession,  to  recognize  the  true 
character  of  the  change  that  has  taken  place  in 
consequence  of  the  introduction  of  this  operation. 
Having  grown  accustomed  to  the  simple,  though 
often  inefficient  operation  of  tonsillotomy  (taking 
off  a  piece  of  the  tonsil)  where  the  operation  was 
performed  and  the  patient  walked  off  to  attend 
to  his  regular  business  of  the  day,  they  have 
failed  to  understand  that  tonsillectomy  (com- 


112  NOSE  AND  THROAT. 

pletely  dissecting  out  every  particle  of  the  tonsil) 
is  a  matter  of  graver  consequence.  Tonsillectomy 
is  unquestionably  the  better  operation  because  it 
accomplishes  what  every  operation  should  at- 
tempt to  do — full  and  complete  removal  of  the 
abnormal  or  diseased  structures.  It  is,  however, 
attended  by  dangers  that  seldom  appeared  in  the 
old,  incomplete  operation;  it  requires  a'  high 
degree  of  skill  for  its  proper  performance,  and 
it  produces  in  most  instances  a  considerable 
degree  of  shock,  which  necessitates  a  period  of 
complete  rest  for  the  patient,  varying  from  three 
days  to  a  week,  according  to  the  constitutional 
strength  of  the  individual.  By  recognizing  these 
facts,  selecting  a  competent,  specially  trained 
surgeon  to  perform  the  work,  and  preparing  one's 
self  as  for  submission  to  any  other  major  opera- 
tion, with  a  sufficient  period  of  rest  following  to 
permit  of  an  untrammeled  convalescence,  much 
good  and  little  danger  can  come  from  the 
operation. 

ADENOIDS. 

In  the  upper  part  of  the  throat,  behind  the 
nose,  the  space  that  is  called  the  vault  of  the 
pharynx  or  the  postnasal  space,  there  is  some- 
times found  a  mass  of  glandular  tissue  which  is 
spoken  of  as  an  "adenoid  growth."  Under 


ADENOIDS.  113 

normal  conditions  the  vault  of  the  pharynx  is 
simply  a  large  air  chamber :  its  roof  is  a  part  of 
the  base  of  the  skull ;  its  posterior  wall,  a  portion 
of  the  back  of  the  throat,  is  a  thin  layer  of  soft 
tissues  covering  the  upper  cervical  part  of  the 
spinal  column;  its  lateral  walls  of  mucous-mem- 
brane-covered muscular  tissues  present,  on  either 
side,  the  orifices  of  the  Eustachian  tubes  which 
permit  the  transmission  of  air  to  the  ear-drums ; 
anteriorly  it  is  marked  by  the  posterior  openings 
of  the  nasal  chambers;  it  has  no  floor.  Physio- 
logically, air  enters  this  space  through  the  nose 
and,  aside  from  that  small  portion  that  is  re- 
quired for  the  ears,  passes  downward  into  the 
larynx  and  bronchial  tubes  on  its  way  to  the 
lungs.  In  the  soft  tissues  of  the  vault  there 
exists  in  the  infant  a  segment  of  a  ring  (com- 
pleted by  extension  through  the  tonsils  and  the 
base  of  the  tongue)  of  gland-like  cells.  Under 
certain  conditions  this  may  develop  into  a  gland- 
ular structure  and  project  into  the  pharyngeal 
space,  when  it  is  recognized  as  an  adenoid 
growth.  In  some  instances  the  growth  increases 
rapidly  and  may  reach  such  size  as  to  completely 
fill  the  postnasal  space  and  even  extend  below  the 
soft  palate  so  that  it  is  visible  on  looking  into  the 
open  mouth.  In  the  majority  of  cases  it  does  not 
approach  this  enormous  size,  but  any  adenoid 


114  NOSE  AND  THROAT. 

projection  whatsoever  in  the  pharyngeal  vault  is 
abnormal  and  may  possibly  cause  trouble.  The 
growth  may  appear  in  one  more  or  less  solid 
mass  or  may  develop  as  a  mass  of  fimbriated, 
partially  separated  projections.  Sometimes 
quite  a  large  mass  is  present  at  birth,  but  more 
frequently  it  develops  gradually  during  the  early 
years  of  life. 

Adenoids  produce  trouble  in  various  ways. 
First,  by  completely  or  partially  occluding  the 
mouths  of  the  Eustachian  tubes  they  prevent 
ingress  of  air  to  the  ears  and  cause  inflammation 
in  the  drum,  followed  by  progressive  deafness. 
Secondly,  by  covering  the  posterior  openings  of 
the  nose  the  mass  acts  like  a  ball-valve  to  ob- 
struct respiration;  air  enters  the  postnasal  space 
through  the  nose,  by  forcing  the  adenoid  back, 
but  as  expiration  takes  place  the  mass  falls  down 
again  over  the  orifices  and,  as  the  air  must  escape 
then  through  the  mouth,  that  well-known  but 
disagreeable  sound  called  a  "snore"  is  produced. 
Thirdly,  being  very  susceptible  to  the  influences 
of  cold,  adenoids  keep  the  child  in  an  almost  con- 
stant state  of  cold  in  the  head  with  all  its  conse- 
quent disagreeable  features.  Fourthly,  by  virtue 
of  the  more  or  less  constant  state  of  inflammation 
maintained  and  of  their  absorptive  properties 
they  produce  a  state  of  autointoxication  which 


ADENOIDS.  115 

makes  the  child  delicate  and  sickly,  as  the  result 
of  which  a  generally  stunted  growth,  an  im- 
perfect physical  development,  retarded  mental 
development,  or  a  general  susceptibility  to  sys- 
temic disease  is  the  common  outcome. 

The  symptoms  of  adenoids  are  generally  easy 
of  recognition.  If  your  baby  has  "snuffles,"  can- 
not feed  properly  (that  is,  sucks  the  breast  for  a 
few  moments  and  then  has  to  cease  in  order  to 
breathe),  snores,  or  is  restless  in  its  sleep,  con- 
sider whether  it  may  not  have  adenoids.  If  your 
older  child  is  a  mouth-breather,  snores  in  his 
sleep,  is  "hatchet-faced"  and  "pigeon-breasted," 
is  not  up  to  the  average  size  of  children  of  the 
same  age,  has  attacks  of  asthma  or  of  croup,  or 
is  dull  and  stupid  at  schoolwork,  look  out  for 
adenoids.  If,  in  addition  to  any  of  these  symp- 
toms, the  child  has  repeatedly  recurring  attacks 
of  earache,  mild  or  otherwise,  there  certainly  are 
adenoids  present. 

The  disastrous  effects  of  adenoids  upon  the 
general  health  can  hardly  be  overstated  and  are 
equalled  only  by  the  counterbalancing  marvelous 
improvement  that  takes  place  when  the  abnormal 
growth  is  removed.  It  is  a  common  occurrence 
to  see  children  of  12  to  14  years  of  age  who,  be- 
cause of  adenoids,  have  not  progressed  in  intellect 
beyond  the  average  child  of  7  or  8,  and  the  same 


116  NOSE  AND  THROAT. 

may  be  said  of  their  stature.  In  contradistinc- 
tion to  this,  it  is  a  delight  to  watch  the  rapid 
physical  growth  and  the  mental  development  that 
follows  the  removal  of  adenoids  from  such  a 
child. 

Nearly  all  of  the  things  that  were  said  about 
the  evil  influences  and  the  dangers  of  enlarged 
and  diseased  tonsils  might  be  here  repeated  with 
equal  truth  about  adenoid  growths,  and  the  same 
things  are,  likewise,  true  as  to  what  should  be 
done  for  them.  Surgical  removal  is  the  only 
treatment  worthy  of  consideration,  and  that 
should  be  instituted  at  the  earliest  convenient 
moment.  Do  not  wait  for  the  child  to  outgrow 
them;  he  will  not  do  so,  and  while  you  are  wait- 
ing in  vain  for  relief  by  that  means  his  hearing 
or  his  general  health  may  become  seriously  and 
permanently  impaired,  or  death  may  carry  him 
off  through  some  intercurrent  disease  that  is 
made  doubly  dangerous  because  of  the  presence 
of  these  abnormal  growths.  The  child  does  not 
need  to  be  "built  up"  for  the  operation;  he  re- 
quires the  operation  in  order  that  he  may  build 
up. 

The  operation  is  not  a  serious  one,  always 
acknowledging  that  any  operation,  however 
simple  it  may  be,  carries  with  it  a  certain  element 
of  risk,  but  should  be  performed  by  a  competent, 


ADENOIDS.  117 

skilled  surgeon  and  with  every  possible  precau- 
tion against  accident  and  provision  for  safe 
convalescence.  In  all  young  children  the  opera- 
tion should  be  done  under  a  general  anesthetic. 
An  operation  attempted  without  anesthesia  is  al- 
most sure  to  be  an  incomplete,  imperfect,  and 
unsatisfactory  one.  Recurrence  after  a  complete 
operation  is  possible,  but  not  probable;  recur- 
rences are  generally  due  to  the  fact  that  the 
growth  was  not  completely  removed  at  the  right 
time.  In  the  necessary  haste  attending  an  opera- 
tion upon  a  child  not  anesthetized  the  surgeon 
cannot  be  sure  he  has  taken  all  of  the  mass,  and 
the  chances  are  strongly  against  his  ability  to  do 
so.  As  after  any  major  operation,  there  should 
follow  a  period  of  quiet  rest  with  the  proper  safe- 
guards against  possible  infection.  Finally,  bear 
this  point  strongly  in  mind;  if  your  child  has  an 
adenoid  or  enlarged  or  diseased  tonsils,  do  not 
hesitate  to  submit  him  to  the  operation  for 
removal  even  though  he  seems  to  be  suffering 
no  inconvenience  from  these  abnormalities  at  the 
time,  because  the  risks  of  the  operation  are 
infinitesimal,  while  the  dangers  of  leaving  the 
thing  alone  are  many  and  great. 


INDEX. 


Abscess  of  eardrum,  dangers 
of,  78 

middle  ear,  78 

Accommodation,  ocular,  16 
Adenoid  operation,  116 
Adenoidectomy,  116 

risks  of,  117 
Adenoids,  112 

as  cause  of  colds,  114 

bad  effects  of,  115 

cause  of  ear  affections,  81 

cause  of  ear  trouble,  114 

causing;  snuffles,  115 

description  of,  112 

growth  of,  113 

how  they  produce  trouble, 
114 

interfering  with  Eustachian 
tube,  114 

obstruction    to   respiration, 
114 

recurrence  of,  117 

removal  of,  116 

symptoms  of,  115 
Alcohol,   as    cause   of   blind- 
ness, 56 

Antrum  of  Highmore,  90 
Anvil,  the,  71 

Apparatus    for    transmitting 
sound  waves,  71 

hearing,  70 

perceptive,  of  the  ear,  71 
Applications   to    eyes,   how    to 

make  them,  60 

Astigmatism,  combined  with 
hypermetropia,  22 

combined  with  myopia,  22 

correction  of,  by  glasses,  32 

discomfort  produced  by,  23 

explanation  of,  21 

simple,  22 


Auditory  nerve,  71 

ossicle,  70 
Auricle,  70 
Auricles,  supernumerary,  74 

Babies,       inflammations       of 
their  eyes,  38 

Bandage,  for  the  eyes,  63 

Bathing    eyes,    how    to    per- 
form, 63 

Blindness,  due  to  ophthalmia 

neonatorum,  38 
due  to  tobacco  and  alcohol, 
56 

Books,  best  paper  for,  44 
best   plan   of   columns   and 

lines,  44 
type  to  be  used  in,  44 

Broken  nose,  91 

Buried  tonsils,  188 

Camera,  nature's,  12 
Car-sickness,  due  to  defective 

eyes,  28 
Cataract,  53 
description  of,  53 
development  of,  54 
in  relation  to  eye-strain,  53 
recovery  from,  55 
ripeness  of,  54 
treatment  of,  54 
Catarrh  of  the  ear,  78,  80 

prevention  of,  81 
nasal,  94 

cause  of  ear  disease,  81 
treatment  of,  95 
nature  of,  96 
Cerumen,  in  the  ear,  76 
Childhood,  care  of  eyes  dur- 
ing, 41 
errors  of  refraction  in,  41 

(119) 


120 


INDEX. 


Chorea,  due  to  eye-strain,  30 
Choroid,  description  of,  14 
Chronic  catarrh,  causes  of,  99 
dangers  of,  99 
symptoms  of,  100 
treatment  of,  102 
Ciliary  muscle,  description  of, 

14 

power  of,  25 
small  size  of,  24 
Cold  applications,  to  eyes,  62 
Colds,  cause  of,  92 
caused  by  adenoid,  114 
dangers  of,  93 
in  head,  92 
nature  of,  92 
treatment  of,  95 
Conjunctivitis,    an    infection, 

52 

cause  of,  51 
treatment  of,  52 
Convergence,  associated  with 

accommodation,  18 
Cornea,  description  of,  13 
Crossed  eyes,  44 
cause  of,  44 
treatment  of,  46 

Deaf-mutes,  education  of,  82 

treatment  of,  83 
Deaf-mutism,  82 
Deafness,  congenital,  82 

from  nasal  catarrh,  81 

nerve,  82 

resulting  from  adenoids,  81 
Desks,  in  the  schoolroom,  43 

relation  of  seat  to,  43 
Disease  of  the  tonsils,  104 
Dropper,  how  to  use  for  eye 

drops,  61 

Drops,  how  to  put  in  eye,  61 
Drum  of  the  ear,  70 

diseases  of,  77 
Drumhead,  70 

Dyspepsia,  due  to  eye-strain, 
30 

Ear,  65 
abscess  of,  78 


Ear,  accumulation  of  wax  in, 
76 

anatomy  of,  70 

catarrh  of,  78,  80 

description  of,  70 

drum  of  the,  70 

drumhead  of,  70 

external,  70 

flaring,  74 

foreign  bodies  in,  74 

internal,  71 

malformations  of,  73 

malposition  of,  74 

special  sense  organ,  65 
Earache,  never  neglect,  84 
Ear-drums,  artificial,  85 

diseases  of,  77 
Education  of  deaf-mutes,  82 
Emmetropia,  18 
Epilepsy,     excited     by     eye- 
strain,  31 
Ethmoid  sinus,  91 
Eustachian  tube,  72 
External  auditory  canal,  70 

ear,  70 
Eye,  11 

accommodation  of,  16 

bandages,  63 

bath  of,  62 

compared  to  camera,  12 

external  muscles  of,  17 

foreign  bodies  in,  48 

function  of,  13 

inflammation   of  baby's,  38 

its  care  in  infancy,  38 

organic  defects  of,  18 

structure  of,  13 

yellow  spot  of,  17 
Eyeball,  description  of,  13 
Eye-cup,  for  bathing  eye,  63 
Eye-headaches    28 
Eye-pain,  meaning  of,  58 
Eyes,  how  to  bandage,  63 
Eye-strain,  cause  of  digestive 
disturbances,  29 

cause  of  headache,  28 

cause  of  stomach  disorders, 
30 


INDEX. 


121 


Eye-strain,  due  to   errors  of 

refraction,   24 
in  childhood,  41 
in  chorea,  30 
in  nervous  affections,  30 
local  evidences  of,  27 
manifestations  of,  26 
part  played  in  causing  epi- 
lepsy, 31 

reflex  symptoms  of,  27 
remote  evidences  of,  27 
removal  of,  31 
styes  in,  27 
variation   of   symptoms   in, 

28 
without  local  symptoms,  27 

Far-sight    (see    Hypermetro- 
pia),  19 

Far-sighted  (hypermetropic), 

19 
meaning  of,  19 

Far-sightedness,    a    mislead- 
ing term,  19 

Flaring  ears,  74 

Flashes,  of  light  in  the  eye, 
58 

Flies,  in  visual  field,  60 

Foreign  bodies  in  ear,  74 

removal  of,  76 
in  eye,  48 
how  to  remove,  49 

Frontal  sinuses,  91 

Glasses,  value  of,  in  relief  of 

eye-strain,  36 
Glaucoma,  52 
Granular  lids,  49 

Hairs,  wild,  48 
Hammer,  the,  71 
Headache,  cause  of,  28 

due  to  defective  eyes,  28 

nasal  origin,  101 

ocular  origin,  28 

when   attributable  to   eyes, 

57 
Hearing  apparatus,  70 


Hearing,  a  marvel  of  nature, 
65 

physiology  of,  72 

power,  accuracy  of,  66 

range  of,  73 
Highmore's  antrum,  90 
Hot  applications,  to  eyes,  63 
Hypermetropia,  action  of  the 
lens  in,  19 

cause  of  squint,  45 

correction  of,  by  glasses,  32 

its  meaning,  19 

shape  of  eye  in,  18 
Hypertrophied  tonsils,   105 

Incus,  71 

Indigestion,    caused    by    de- 
fective eyes,  29 
Infancy,  care  of  eyes  in,  38 
Internal  ear,  71 
Iris,  description  of,  14 
Iritis,  52 

Lens,  action  of,  15 

description  of,  15 
Lids,  granulation  of,  49 
Light,  in  the  schoolroom,  43 

flashes,  in  the  eye,  58 
Lights,     best     position     for 
reading,  47 

value  of  different,  47 
Lotions,  use  on  eyes,  63 

Malformations  of  the  ear,  73 
Malleus,  the,  70 
Middle  ear,  abscess  of,  78 
cure  of,  80 
dangers  of,  78 
catarrh,  78 
diseases  of,  77 
Mouth-breathing,    108,    115 
Muscle,  ciliary,  14 

power  of,  25 

Muscles,  external  ocular,  17 
Mutism,  from  deafness,  82 
Myopia,  20 

action  of  lens  in,  21 
correction  of,  by  glasses,  32 


122 


INDEX. 


Myopia,    reason    for    distant 

vision  in,  21 
shape  of  eye  in,  20 

Nasal  catarrh,  94 

a  cause  of  deafness,  81 
chronic,  treatment  of,  102 
cold,  92 
headaches,  101 
mucous  membrane,  90 
septum,  89 
sinuses,  90 

infection  of,  100 
structure,  89 
Near-sightedness      (myopia), 

20 

Nerve-deafness,  82 
Nerve  of  hearing,  71 
Nervous    disorders,    due    to 

eye-strain,  30 

prostration,     due     to     eye- 
strain,  30 
Nose,  87 
anatomy  of,  89 
deformities  of,  91 
fracture  of,  91 
physiology  of,  91 
structure  of,  89 
turbinate  bones  of,  90 

Oculist,  the  broad  importance 

of  his  work,  32 
the  work  of  the,  32 
varying  skill  of,  36 
Ointments,  how  to  apply  to 

eye,  62 
Old-age    sight    (presbyopia), 

23 

Ophthalmia  neonatorum  (in- 
flammation of  baby's 
eyes),  38 

a  preventable  disease,  38 
blindness  from,  38 
danger  of,  to  others,  40 
how  to  prevent,  39 
treatment  of,  40 
virulence  of,  38 
of  newborn  babe,  38 
Optic    nerve,    entrance    into 
eye,  14 


Optician,  legitimate  field  for 

his  skill,  34 
work  and  limitations  of  the, 

33 

Ossicles,  auditory,  the  func- 
tion of,  72 
ear,  70 
Overflowing  tears,  59 

Pain,  in  the  eye,  58 
Perceptive   apparatus   of  the 

ear,  71 
Physiology  of  hearing,  71 

nose,  91 

vision,  13 

Pink-eye  (conjunctivitis),  51 
Presbyopia,  action  of  lens  in, 
23 

explanation  of,  23 
Prevention  of  ear  catarrh,  81 

ear  disease,  81 

earache,  81 
Pupil,  explanation  of,  15 

Rainbow  lights,  in  the  eye,  58 
Reading,  position  of  body  in, 

47 

position  of  light  in,  47 
while  lying  down,  47 
Refraction  of  light,  18 
Removal  of  adenoids,  116 
foreign  bodies  from  ear,  75 

from  eye,  49 
tonsils.  Ill 

Retina,  description   of,   16 
Rheumatism,  caused  by  ton- 
sils, 108 
Rhinitis,  92 
acute,  92 
causes  of,  92 
chronic,  94 

Risley's    (Dr.    S.    D.)    advice 
on  school  arrangements 
for  children,  42 
Running  ears,  78 
dangers  of,  79 
never  neglect,  85 
treatment  of,  80 


INDEX. 


123 


Schools,  desks  in,  43 
lighting  of,  43 
Dr.     Risley's    advice    on 
means     to     save     chil- 
dren's eyes,  42 
Sclerotic,  description  of,   14 
Sense  of  smell,  loss  of,  101 
Septum  of  the  nose,  89 
Shrinking  of  tonsils,  109 
Sick-headache,    due   to    accu- 
mulative    eye-strain,    29 
Sight,  appreciation  of,  11 
Sinus,  ethmoid,  91 
frontal,  91 
sphenoid,  91 

Sinuses,  nasal,  disease  of,   100 
Smell,  loss  of  sense  of,  101 

sense  of,  87 
Snoring,  because  of  adenoids, 

114 
Snuffles,  caused  by  adenoids, 

115 

Sound,  explanation  of,  68 
musical,  69 
waves,  68 

Spasm  of  eyelids,  26 
Spectacles,  assistance  of,  in  re- 
lieving   ocular    defects, 
36 

Sphenoid  sinus,  91 
Spots,  before  the  eye,  60 
Squint,  44 
cause  of,  45 

relationship  to  errors  of  re- 
fraction, 45 
treatment  of,  46 
Stapes,  71 
Stirrup,  the,  71 
Stomach    disorders,    due    to 

eye-strain,  30 
Structure,  nasal,  89 
Styes,    associated    with    eye- 
strain,  27 
cause  of,  51 
prevention  of,  51 
treatment  of,  51 
Submerged  tonsils,  108 


Taste,  sense  of,  87 
Tear  drop,  meaning  of,  59 
treatment  of,  60 

ducts,  90 
Throat,  the,  87 
Tobacco  blindness,  56 

effect  of,  on  the  eyes,  56 
Tonsil  operations,  111 

risks  of,  112 
Tonsillectomy,  111 

risks  of,  112 
Tonsillitis,  105 
Tonsillotomy,  111 
Tonsils,  affections  of,  104 

as  cause  of  rheumatism,  108 

atrophy  of,  104 

cause  of  ear  affections,  81 

cheesy  particles  in,  108 

dangers  of,  110 

disappearance   of,   104 

effect  of  diseased,  105 

failure  to  atrophy,  110 

function  of,  104 

hypertrophy  of,  105 

influence  on  ears,  105 

influence  on  voice,  106 

removal  of,  111 

shrinking  of,  109 

submerged,  108 

treatment  of,  189 
Trachoma,  49 
Transmitting     apparatus     of 

the  ear,  71 

Turbinate  bones   of  nose,  90 
Twitching  of  lids,  26 
Type,   size   of,   for  easy  read- 
ing, 44 

Voice,  affected  by  tonsils,  106 

Waves,  sound,  68 

Wax,  accumulation  of,  in  the 

ear,   76 

Wild  hairs,  48 
Wrinkles,   due  to   eye-strain, 

27 

Yellow  spot,  of  the  retina,  17 


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